Vol. XIII No. 18 ~ EINet News Briefs ~ Sep 03, 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
- Europe: Regulators probe narcolepsy reports with pandemic H1N1 influenza vaccine
- Australia: CSL recalls pediatric pandemic H1N1 influenza vaccine
- Chinese Taipei: H5N1 avian influenza vaccinations offered to public
- New Zealand: More H1N1 pandemic influenza deaths logged as infection rises in Australia
- Egypt: Confirmed case of fatal H5N1 avian influenza

2. Infectious Disease News
- Australia (New South Wales): Measles outbreak
- Japan: Foot and mouth epidemic declared over
- Malaysia: Leptospirosis fatalities
- Russia: Anthrax cases
- Thailand: Meliodosis
- Peru: PAHO rabies alert
- USA: Ground beef recall due to E. coli VTEC non-O157
- USA: Congress food watchdog sets egg-recall hearing
- USA: FDA reports investigate Salmonella risk at egg farms
- USA: 23 states affected by egg recall
- USA: Salmonella outbreak linked to feed
- USA: FDA reports show biosecurity gaps at two egg farms
- USA (California): Program effective against Salmonella in eggs
- USA (Illinois): TB outbreak being contained
- USA: National pertussis report
- USA: Federal contract supports more work on adjuvanted anthrax vaccine
- USA: Production problems decrease smallpox vaccine delivery to US

3. Updates

4. Articles
- Flutracking provides a measure of field influenza vaccine effectiveness, Australia, 2007–2009
- Universal Influenza Vaccination: An Optimal Goal—But How and When?
- Influenza Vaccination of Household Contacts of Newborns: A Hospital‐Based Strategy to Increase Vaccination Rates
- Results of a National Survey of Infectious Diseases Specialists regarding Influenza Vaccination Programs for Healthcare Workers
- Knowledge and attitudes regarding influenza vaccination among nurses: A research review
- Safety of MF59-adjuvanted versus non-adjuvanted influenza vaccines in children and adolescents: An integrated analysis
- Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel
- Hospital Discharge Data for Guillain-Barre Syndrome and Influenza A (H1N1) Vaccine Adverse Events
- Facial Protective Equipment, Personnel, and Pandemics: Impact of the Pandemic (H1N1) 2009 Virus on Personnel and Use of Facial Protective Equipment
- Hospitalized adult patients with 2009 influenza A(H1N1) in Beijing, China: risk factors for hospital mortality
- Changes in knowledge, perceptions, preventive behaviors and psychological responses in the pre-community outbreak phase of the H1N1 epidemic
- Design of a robust infrastructure to monitor the safety of the pandemic A(H1N1) 2009 vaccination program in Taiwan
- Perceptions of Immunization Information Systems for Collecting Pandemic H1N1 Immunization Data within Canada's Public Health Community: A Qualitative Study
- Predicting Need for Hospitalization of Patients with Pandemic (H1N1) 2009, Chicago, Illinois, USA
- Persistence of Avian Influenza Virus (H5N1) in Feathers Detached from Bodies of Infected Domestic Ducks
- Do as I say, not as I do: Handwashing compliance of infectious diseases experts during influenza 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

2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Cambodia / 1 (1)
China / 1 (1)
Egypt / 22 (9)
Indonesia / 6 (5)
Viet Nam 7 (2)
Total / 37 (18)

***For data on human cases of avian influenza prior to 2010, go to:

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 505 (300)
(WHO 08/31/10 http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_08_31/en/index.html

Avian influenza age distribution data from WHO/WPRO (last updated 2/8/10):

WHO's map showing world's areas affected by H5N1 avian influenza (status as of 2/12/10):

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


Global: WHO situation update on pandemic influenza H1N1
Worldwide, H1N1 2009 virus transmission remains most intense in parts of India and in parts of the temperate southern hemisphere, particularly New Zealand and more recently in Australia.

In India, the current national influenza H1N1 2009 epidemic, which first began during late May and June 2010 in the southern state of Kerala (co-incident with start of the monsoon rains), continues to remain regionally intense in several western and southern states as well as the in the capital. The western state of Maharashtra, which to date, has detected the highest numbers of cases (including fatal cases), continues to record the most intense influenza H1N1 2009 activity, however, the rate of increase in the numbers of new cases reported per week appears to have slowed during mid-August 2010, suggesting that current epidemic activity may be peaking. Increasing H1N1 2009 activity has also been reported in Delhi since early August 2010, and in the southern states of Karnataka and Andhra Pradesh since late July 2010. A number of other states, primarily in western and northern India, reported small numbers of new cases during the third week of August 2010, suggesting that low level circulation of H1N1 2009 may be more geographically extensive. Since late July 2010, the vast majority of influenza virus detections have been H1N1 2009.

In New Zealand, H1N1 2009 virus transmission remains active and locally intense, particularly in areas that were less affected during last winter's first pandemic wave. As of the third week of August 2010, the overall national weekly rate of consultations for ILI continued to increase above the seasonal baseline for the fourth consecutive week, however, the rate of increase in ILI consultations appears have slowed during the most recent reporting week, suggesting that peak epidemic activity may occur in the weeks ahead. Although the overall national rates of ILI consultations has not exceeded levels seen during the 2009 winter pandemic wave, several areas of New Zealand, most notably Hawke's Bay, Hutt Valley and Lakes, are all reporting local rates of ILI consultations that match or surpass rates seen at the national level at the peak of last winter's pandemic wave. The vast majority of influenza virus detections during the current epidemic period have been H1N1 2009.

In Australia, during the first two weeks of August 2010, data from several surveillance systems indicate that influenza activity is increasing, including a one week increase in the national rate of ILI consultations, regional spread of ILI activity in three southern and eastern states, and a sharp two week rise in the proportion of sentinel respiratory samples testing positive for influenza virus (an increase from 5 to 15%). However, overall national rates of ILI consultations remain well below levels observed during the 2009 winter pandemic wave. The majority of recent influenza virus isolations have been characterized as H1N1 2009, however, seasonal H3N2 viruses have also been detected at low levels. Of note, an online influenza surveillance system that tracks the rate of ILI in the community found that recent increases in the rate of ILI have been among persons who were unvaccinated against H1N1 2009 virus. Although significantly fewer severe and total cases of H1N1 2009 virus infection have been detected this year compared to last winter, the median age of H1N1 2009 virus infected cases appears to similar although slightly older (21 vs. 26 years old).
(WHO 08/27/2010)


Europe/Near East
Europe: Regulators probe narcolepsy reports with pandemic H1N1 influenza vaccine
Europe's drug regulatory agency 27 September 2010 announced that it has launched a review of Pandemrix, the 2009 H1N1 vaccine, in the wake of a limited number of reports of narcolepsy through reporting systems in Finland and Sweden. The European Medicines Agency (EMA) said it's not clear if the vaccine caused the narcolepsy, which is typically triggered by a combination of genetic and environmental factors, including infections. The EMA said it will review all available data to determine of there may be a link between the vaccine and the condition and consider the background rate for narcolepsy. The group will decide at its meeting in September 2010 whether to take any action on the vaccine while it completes the evaluation.
(CIDRAP 08/27/2010)


Australia: CSL recalls pediatric pandemic H1N1 influenza vaccine
Australia-based CSL is recalling its Panvax Junior pediatric 2009 pandemic H1N1 vaccine because of declining potency as it has reached its 12-month shelf life, the company said 24 August 2010. The company emphasized that the recall does not affect the company's trivalent influenza vaccine, which contains the 2009 pandemic H1N1 strain. Other companies recalled their monovalent H1N1 vaccines late in 2009 and earlier in 2010 because of a similar loss in potency.
(CIDRAP 08/25/2010)


Chinese Taipei: H5N1 avian influenza vaccinations offered to public
The Taiwan Centers for Disease Control is offering H5N1 avian influenza vaccine to the public during September 2010, using 190,000 doses that are due to expire in November 2010. Chou Jih-Haw, the agency's deputy director, recommended vaccination for medical personnel involved in disease control, animal quarantine officers, security screeners at airports and seaports, coast guard officers, and people who visit countries battling avian flu. He said the vaccine will be free, but recipients will need to pay registration and medical examination fees at designated vaccination sites.
(CIDRAP 09/01/2010)


New Zealand: More H1N1 pandemic influenza deaths logged as infection rises in Australia
From 23 August to 26 August 2010, New Zealand has seen five new deaths, 82 hospitalizations, and 14 admissions to intensive care units (ICUs) linked to 2009 pandemic H1N1 flu, according to the country's Ministry of Health (MOH). This brings the 2010 totals to 583 hospitalizations, 91 ICU admissions, and 15 deaths, the MOH said, as it continues to urge vaccination. Meanwhile, neighboring Australia is reporting an increase in novel H1N1 cases, according to the country's Influenza Specialists Group (ISG). ISG Chairman Dr. Alan Hampson said that the increased cases plus New Zealand's flu experience means that outbreaks are imminent. Hampson said Australia's flu season typically lags a bit behind New Zealand's. Lab-confirmed influenza cases have jumped in Victoria, South Australia, and Queensland.
(CIDRAP 08/27/2010)


Egypt: Confirmed case of fatal H5N1 avian influenza
The World Health Organization (WHO) 31 August 2010 confirmed the illness and death of an Egyptian woman from the H5N1 avian influenza virus. The 33-year-old woman from Qalubia governorate got sick on 17 August 2010 and was hospitalized and treated with oseltamivir (Tamiflu) on 24 August 2010. She died 26 August 2010. An investigation into the source of her illness revealed that she had been exposed to sick and dead poultry. Egypt now has had 112 H5N1 cases with 36 deaths. The latest case raises the world's H5N1 count to 505 cases, including 300 deaths.
(CIDRAP 08/31/2010)


2. Infectious Disease News

Australia (New South Wales): Measles outbreak
People are being reminded to check their vaccination history before travelling overseas after an outbreak of measles on the New South Wales [NSW] north coast. The state's Health Department says five people have contracted the highly infectious illness after contact with a traveler who brought the disease into the area. Two other travelers have also contracted the disease during August 2010.

The NSW Health director of communicable disease, Dr Jeremy McAnulty, says people can easily spread the disease if they do not check their vaccination history. Measles is a nasty disease, and it's highly preventable by vaccination, he said.
(ProMED 08/20/2010)


Japan: Foot and mouth epidemic declared over
With the deadly foot-and mouth [FMD] epidemic finally declared over four months after it started racing through the prefecture's livestock, local farmers have begun setting their sights on a comeback.

However, there are many serious concerns about how the outbreak has affected other local industries, including commerce and travel. Farmers, meanwhile, say the recovery has barely begun.

It's as if we've just gotten over the first mountain...I'm at a loss for words, Gov. Hideo Higashikokubaru said 27 August 2010. He read aloud the proclamation declaring an end to the deadly epidemic. The epidemic has seriously affected our economy and recovery will be no easy feat, Higashikokubaru said, emphasizing the many problems still faced by the prefecture.

Some local farmers who are hoping to begin raising animals again also have expressed their concern.

The central government during August 2010 will finish issuing subsidies to farming households affected by the cull. While the government will provide assistance to help them get their businesses up and running again, it is not clear whether this "income" is subject to taxes. If so, income tax will take away a considerable amount.

Rumors, too, continue to inflict damage. According to the Miyazaki Trucking Association, the 38 shipping companies operating in the prefecture have been turned away when trying to make deliveries in some places outside the prefecture. They've also been told to not make deliveries in trucks with Miyazaki plates.

A recent Agriculture, Forestry and Fisheries Ministry canvas of retailers nationwide discovered 16 instances of inappropriate signage declaring, "We do not carry Miyazaki beef or pork."

The real fight is just beginning," says a Takanabecho pig farmer who lost 3,000 animals during the epidemic. In July 2010, he and another farmer formed the "new pork project" committee, which plans to take action to prevent future outbreaks in the area. We're hoping for a quick recovery, but at the same time we also plan to look 30 years down the road, he said.

With the epidemic officially declared over, Tachikawa Takashimaya department store in Tachikawa, Tokyo, began a promotion of Miyazaki beef, with discounts of 20 percent to 30 percent. The store said that in June and July 2010, it received 212 messages of support for the affected farmers of Miyazaki Prefecture.
(ProMED 08/28/2010)


Malaysia: Leptospirosis fatalities
Malaysia has closed parks and alerted the public about the danger of swimming and throwing garbage into rivers to prevent a disease transmitted by rats that has apparently caused some 10 deaths.

A new death from leptospirosis occurred on 21 August 2010. The victim was a 17-year-old from the northern state of Kedah who had swum in a river and attended a picnic with friends at a recreation park in July of 2010.

Several parks in the country have been closed since the first deaths were reported July 2010. It is believed that some of the deaths were caused by another condition, and a Health Ministry official could not say immediately how many deaths were due to leptospirosis.

The website of the Ministry of Health warns people not swim in public rivers when it rains and to avoid diving if they have wounds on the body because it would facilitate infection.

The head of the agency, Liow Tiong Lai said the ministry would distribute flyers and posters to give out information about the disease.

Leptospirosis is caused by exposure to water contaminated with urine of infected animals and is absorbed through the skin. Rats are the primary carriers, and the ministry campaign urges people not to throw debris near water because it could attract the animals, he said.

The cases of the disease have increased in Malaysia. In 2004 there were 263 infected and 20 deaths, while in 2009 the figure rose to 1,400 infected and 62 deaths.

Symptoms include severe muscle pain, fever, vomiting and headache. Leptospirosis is treatable if the person receives treatment in the first week.
(ProMED 08/23/2010)


Russia: Anthrax cases
A spokesman for the regional emergencies service told RIA Novosti that two residents of a remote farmstead in Russia's North Caucasus Republic of Dagestan have been diagnosed with anthrax.

The patients are two men, born in 1957 and 1967. They are now in satisfactory condition, the source said. The men contracted the disease after eating an anthrax-infected sheep.

A total of four people also living at the farmstead have been vaccinated against the disease and received prevention treatment. Their health is now being monitored, and none developed symptoms so far.

All sheep at the farm have been quarantined for a month. No other cases of the disease have been detected.

[ProMED moderator note: I suspect that these two farm workers were in fact afflicted with cutaneous anthrax, not gastroenteric anthrax. Two men on a remote Caucasus farmstead would probably not survive long enough to reach the local medical clinic with the enteric form of this disease, much less respond well to treatment. On the other hand the skin form is easier to diagnose and its risks are less. Plus cutaneous anthrax is about 100 times commoner.

I had a query as to whether we were getting more reports than usual of anthrax and thus maybe indicative of climate change. I doubt it. This disease is routinely under-diagnosed, much less missed being noted at all in deep rural areas. If this outbreak had not involved two human cases the ovine problem would have been probably ignored. Individual sheep deaths are virtually invisible.]
(ProMED 08/28/2010)


Thailand: Meliodosis
An outbreak of the water-borne disease melioidosis has infected 1,307 people and caused six deaths in 2010 mainly among farmers in the Northeast.

Public health minister Jurin Laksanawisit has warned farmers to avoid wading through water and walking over soil with bare feet because the bacterium Burkholderia pseudomallei, which causes melioidosis, is common in soil and water. Please wear boots, Jurin said. If you have a fever, please go to see a doctor, he said.

Victims were also recommended to tell their doctors about their occupation and location of their houses to allow an accurate diagnosis. Due to its flu-like symptoms and potentially long incubation period, melioidosis can be difficult to diagnose.
(ProMED 08/25/2010)


Peru: PAHO rabies alert
In epidemiological week (EW) 30 of 2010, Peru's Ministry of Health reported the death of a confirmed case of human rabies transmitted by a hematophagous bat. This case occurred in the native community of Urakusa, district of Nieva, province of Condorcanqui, department of Amazonas. (The native community of Urakusa is located on the right shore of the Maranon River and has a population of approximately 828 people, who belong to the Aguajun ethnicity.) On EW 33 a new death was reported, in the native community of Suhapangkis, located in the same province.

The first case corresponds to an unvaccinated four-year-old boy, who was bitten in the head on 3 June 2010. The second case is an unvaccinated five-year-old boy who rejects vaccine for cultural beliefs.

Currently, a team is working in the field, where an active search and vaccination of people exposed to bat bites is underway.

This district has had rabies outbreaks records in the native communities of Cachiaco (2009), Kigkis (2009-2010), and Sumpa (2010).

[PAHO Editorial Note: Most human cases of vampire bat-transmitted rabies have occurred in the Amazon region of Brazil and Peru and in some remote communities of Colombia. Vampire bats are found only in Latin America. Of the three known species -- Diphylla ecaudata, Diaemus youngi, and Desmodus rotundus (the common vampire) -- only the latter has been known to feed on mammals and thus has possibly transmitted rabies virus in the human outbreaks studied.

In the Americas, human rabies transmitted by dogs has been almost eliminated, although the canine population is still at risk in various countries. Rabies persists mostly in wild animals. In recent years rabies in bats has resurfaced as a public health problem in the Americas. In 2004 for the first time more people died as a result of exposure to wild animals, especially bats, than to dogs in South America. The occurrence of human rabies outbreaks transmitted by hematophagous bats is cyclical, thus, it is important to maintain an active surveillance and act preemptively in areas of high risk.]
(ProMED 08/30/2010)


USA: Ground beef recall due to E. coli VTEC non-O157
Cargill Meat Solutions Corp. has recalled about 8,500 pounds of ground beef that may be contaminated with E. coli, the U.S. Department of Agriculture announced 28 August 2010. The move came after three people, two in Maine and one in New York, were identified as becoming ill from a strain of E. coli, the government said.

None of the three required hospitalization, said Cargill Inc. spokesman Mike Martin.

The USDA says it believes certain BJ's Wholesale Club stores in Connecticut, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York and Virginia received the products. The recalled ground beef was shipped on 11 June 2010 to distribution centers, where it was repackaged into consumer-size packages and sold under different retail brand names. The USDA did not identify the brands.

The recalled beef bears the USDA establishment number "EST. 9400," a product code of "W69032" and a "use/freeze by" date of 1 July 2010.

The USDA's Food Safety and Inspection Services, which said it became aware of the problem on 5 August 2010, "determined that there is an association between the ground beef products subject to recall and the cluster of illnesses in the states of Maine and New York."

Saturday's statement identified the strain as E. coli 026, which can cause bloody diarrhea, dehydration and, in severe cases, kidney failure.

The government "strongly encourages consumers to check their freezers and immediately discard any product subject to this recall."

The government lists the recall as Class 1, meaning "there is a reasonable probability that the use of the product will cause serious, adverse health consequences or death."
(ProMED 08/31/2010)


USA: Congress food watchdog sets egg-recall hearing
The US House Committee on Energy and Commerce 26 August 2010 announced that it will hold a hearing on 14 August 2010 to address the safety of the nation's food supply in the wake of a recent Salmonella Enteritidis outbreak linked to two Iowa farms.

The outbreak has led to the recall of about 550 million eggs, and federal health officials have received reports of 1,470 illnesses so far that they believe are likely related to the contaminated eggs.

In other developments, an announcement by the US Food and Drug Administration (FDA) yesterday that its investigators have found the outbreak strain in chicken feed, feed components (bone meal), and environmental samples at Wright County Egg has prompted a report from the company. Wright County Egg said that it got the bone meal product from a third-party supplier, Central Bi-Products, based in Minnesota.

According to the Central Bi-Products Web site, the company has rendering facilities in Redwood Falls and Long Prairie, Minn., that process raw materials from different species, including poultry material, feathers, and blood. It says each process has its own protein-blending plant, providing product segregation.

Meanwhile, Iowa officials are reviewing if the feed mill located on one of the Wright County Egg farms should have been licensed and inspected. The mill reportedly has a licensing exemption because it makes feed for its own farms, but the FDA said yesterday that Wright County Egg provided potentially contaminated feed to Hillandale Farms, the other Iowa company linked to the national outbreak and egg recall.

An official with the Iowa Department of Agriculture said the state would investigate if Wright County Egg owns part of Hillandale Farms. The farms have said they are separate but share some suppliers.
(CIDRAP 08/27/2010)


USA: FDA reports investigate Salmonella risk at egg farms
Reports of mice, other pests, and manure piles in the US Food and Drug Administration 's (FDA's) initial egg farm investigation findings the week of 30 August 2010 are still reverberating among the public, the industry, and longtime observers of poultry and egg production.

Though the FDA has had some authority to regulate egg farms, the launch of new egg safety rules in July 2010 for large producers imposed more stringent and specific Salmonella Enteritidis (SE) prevention targets. The national SE outbreak and recall of about 550 million eggs from two large Iowa producers prompted the FDA's first extensive egg farm inspection under the new rules, which led to long lists of findings contained in the agency's Form 483 inspection reports released on 30 August 2010.

David A. Halvorson, DVM, an avian health expert who is retired from the University of Minnesota, has spent more than 40 years visiting poultry houses in most US states and Canadian provinces and in Mexico, South America, Europe, and Asia. He said he was still analyzing the 483 inspection reports and was not in a position to support or criticize the egg farmers or the FDA findings. However, he offered observations that relate to some of the SE risk factors found on the farm. In general, he suggested that some of the FDA's findings are not as surprising as they might seem at first glance.

So far the FDA has announced some positive SE lab findings in environmental samples, feed produced at one of Wright County Egg's farms, and egg wash water from a Hillandale Farms facility, but it hasn't announced any positive or negative findings from tests on the eggs. FDA spokeswoman Pat El-Hinnawy said the FDA has collected hundreds of samples from Wright County Egg and Hillandale Farms, and lab results on most of them are still pending.

Halvorson said mice play an important role in SE ecology, so mouse control is critical in an egg production operation. Feces from SE-infected mice can contaminate poultry feed, transmitting the disease to chickens. In the 483 reports, federal investigators said they found live mice in some of the poultry barns and evidence of unsealed rodent holes in some others. A farm that has a million hens consumes about 250,000 pounds of feed each day, he said. Even a very small amount of spilled feed attracts pests. So far, eradicating pests from a farm has not been possible, so a constant effort to control them is necessary,” he said.

Observing 31 mice over a period of 18 days in perhaps 50 or 60 poultry houses might or might not be considered excessive, Halvorson said.

Wild birds theoretically may play a role in SE transmission, he said. The inspection reports detailed evidence of wild birds in some of the poultry barns and around the feed mill. Halvorson said wild birds can enter poultry facilities when doors are opened to allow tractors to enter. So a wild bird in a poultry house, while not desired for many reasons, does happen, he said.

Flies also may play some role in spreading SE, but a significant role has not been established, he said. In the 483 reports, FDA investigators found numerous live and dead flies in the poultry barns, including around the egg conveyors. Halvorson said a farm that has one million hens typically produces about 250,000 pounds of manure each day.

Manure is an excellent substrate for fly reproduction, so flies, and also maggots, are a fact of life on a farm that produces animals, he said, adding that it would be unusual not to find flies on an animal farm, and the presence of flies means maggots are nearby.

The 483 reports also described several other biosecurity lapses, such as gaps in walls and doors, holes in feed ingredient bins, and access doors that were pushed open from the weight of accumulating manure.

Handling large volumes of manure usually requires either tractors to enter the barns through large doors or conveyors to penetrate barn walls to move manure out, Halvorson said. It's not unusual to see gaps around doors and conveyors, he said.

Inspectors said they observed instances of employees not changing or wearing protective clothing when moving from laying house to laying house, according to the 483 reports. Halvorson said in his many years of visiting poultry houses, he doesn't recall seeing workers routinely change clothing when going from one house to the next, though he said changing clothes when going between adult chickens and chicks is a common practice.

On the day the FDA released its findings, Halvorson said the egg safety inspections break new ground for the agency's inspectors and seem to herald a shift away from assuring that farms are free from SE and more toward making sure firms are complying with SE prevention plans.

He said requirements such as changing clothes between barns connected by an egg conveyor and forbidding employees to own pet birds are inexplicable and indicate a lack of understanding of farm operations and SE biosecurity, respectively. He added that the FDA would help egg producers as well as consumers by focusing prevention efforts on known successful mitigation strategies: SE-negative chicks, rodent control, an SE-negative environment, and vaccination.

Though Iowa, the nation's biggest egg producer, is among states that do not have their own egg quality assurance programs for farms, a spokeswoman for Wright County Egg has said the company was in compliance with the new federal rules as well as an industry-based food safety program that addresses cleaning and disinfection of poultry houses, pest control, proper egg washing, biosecurity, and refrigeration from packing through delivery.

In the wake of the inspection reports, both Wright County Egg and Hillandale Farms have issued statements saying they're fixing the problems reported by the FDA inspectors.

FDA officials said that over the next 15 months (2010-2011) investigators will inspect about 600 of the nation's largest egg producers, starting in September 2010 with the facilities that are at highest risk.

In other developments, FDA inspectors returned to the two farms 31 August 2010. An FDA spokeswoman and a federal attorney who covers Iowa confirmed that the agents were at the sites but did not reveal why they were there.

At a 30 August 2010 media briefing about the 483 reports, FDA officials didn't say what their next steps would be in response to the egg safety violations they found. The options could include seizure, injunction, or even criminal prosecution.
(CIDRAP 09/01/2010)


USA: 23 states affected by egg recall
Agriculture officials in Michigan said 24 August 2010 that eggs connected to the national Salmonella-related recall have been distributed in the state, though it wasn't mentioned in recall notices by the two Iowa companies at the center of the investigation, Wright County Egg and Hillandale Farms.

The Michigan Department of Agriculture said in a statement that an ongoing traceback investigation has revealed that some of the companies' customers are distributors and wholesalers that sold the eggs to Michigan customers.

Michigan's announcement raises the number of states affected by the recall to 23, according to a review of company recall notices. The two companies have recalled about 500 million eggs. Four smaller companies that repackaged and resold the eggs from the two companies have also issued recalls.

State officials said they are working with federal investigators to determine where the Michigan eggs were sold and will conduct recall effectiveness checks to ensure that affected products are removed from store shelves.

In other developments, millions of eggs still being produced each day at the two companies are being pasteurized and can be sold as liquid eggs or added to other products such as ice cream, the Canadian Press (CP) reported today. Julie DeYoung, a spokeswoman for Hillandale Farms, told the CP that its chickens are producing about two million eggs a day.

The companies told the CP that they are waiting to hear from the US Food and Drug Administration (FDA) before deciding what to do with the flocks. The FDA cannot order the companies to cull flocks that may be infected with Salmonella, but companies may decide to do so on their own.

Meanwhile, new details emerged today about early clues that led California health officials to suspect an egg link to Salmonella Enteritidis case clusters. Michael Sicilia, a spokesman for the California Department of Public Health, told CNN that more than 30 people who attended a prom and graduation party in Santa Clara County got sick, and some of them were hospitalized.

A case control study found that many had eaten custard-filled profiterole pastries that were served at both the prom and the party. The company that catered the event ran out of pasteurized filler and made the rest of the filling with shell eggs. Tests on the eggs revealed Salmonella, and investigators sent an electronic alert to a national health official network.

Sicilia told CNN that clusters related to the outbreak and recall were also identified in San Diego County at a Korean restaurant and in Los Angeles County on a movie set.

In new recall developments, Wright County Egg said that it is adding one more brand to its recall, Cardenas Markets, whose brand of eggs were distributed to Cardenas Market stores in California and Nevada. Though the brand wasn't named in Wright County Egg's original recall, the stores were notified at the time of the recall and the products were removed from store shelves and quarantined, returned, or destroyed.
(CIDRAP 08/25/2010)


USA: Salmonella outbreak linked to feed
From 1 May to 25 August 2010, a total of 2,403 Salmonella illnesses were reported. Consumers are urged to not eat recalled eggs. Recalled eggs might still be in grocery stores, restaurants, and consumers' homes. Consumers who have recalled eggs should discard them or return them to their retailer for a refund. A searchable database of products affected by the recall is available to consumers. Individuals who think they might have become ill from eating recalled eggs should consult their health care providers.

CDC is collaborating with public health officials in multiple states, the FDA, and the USDA's Food Safety and Inspection Service to investigate a nationwide increase of Salmonella (enterica serotype) Enteritidis (SE) infections with an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern JEGX01.0004. This is the most common PFGE pattern for SE in the PulseNet database. Investigators are using DNA analysis of Salmonella bacteria obtained through diagnostic testing to identify cases of illness that may be part of this outbreak. Because the outbreak PFGE pattern (outbreak strain) commonly occurs in the USA, some of the cases identified with this outbreak strain may not be related to this outbreak.

In early July 2010, CDC identified a nationwide sustained increase in the number of S. Enteritidis isolates with PFGE pattern JEGX01.0004 uploaded to PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of food-borne infections. This increase began in May 2010, and is evident in the epidemic curve, or epi curve. From 1 May to 25 Aug 2010, a total of 2,403 illnesses were reported. However, some cases from this time period have not been reported yet, and some of these cases may not be related to this outbreak.

Based on the previous five years of reports to PulseNet, we would expect approximately 933 total illnesses during this same period. Many states have reported increases of this pattern since May 2010. Because of the large number of expected cases during this period, standard methods of molecular subtyping alone are not sufficient to determine which reported cases might be outbreak-associated. CDC is currently conducting testing using advanced molecular methodologies to help distinguish between outbreak-related cases and sporadic (or background) cases.

Illnesses that occurred after 23 July 2010 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of two to three weeks for Salmonella.

Epidemiologic investigations conducted by public health officials in 10 states since April 2010 have identified 26 restaurants or event clusters where more than a single ill person with the outbreak strain has eaten. Data from these investigations suggest that shell eggs are a likely source of infections in many of these restaurants or event clusters. Preliminary information indicates that Wright County Egg, in Galt, Iowa, was an egg supplier in 15 of these 26 restaurants or event clusters. To date, no new restaurant or event clusters have been reported to CDC. A formal traceback was conducted by state partners in California, Colorado, and Minnesota, in collaboration with FDA and CDC, to find a common source of shell eggs. Wright County Egg in Iowa was found as the common source of the shell eggs associated with three of the clusters. Through traceback and FDA investigational findings, Hillandale Farms of IA, Inc. was identified as another potential source of contaminated shell eggs contributing to this outbreak. FDA is currently conducting extensive investigations at both of these firms in Iowa. The investigations involve sampling, records review, and looking for potential sources of contamination, such as feed.

Laboratory tests have confirmed that two Iowa egg companies are contaminated with the same strain of Salmonella blamed for a national outbreak of illness, which continues to claim victims and has sickened at least 1,500 people, federal officials said 26 Aug 2010.

The confirmation backs up suspicions by the FDA that tainted eggs from the two Iowa producers have caused the biggest case of Salmonella Enteritidis disease that federal officials have seen since they began tracking the illness in the 1970s.

The FDA, which has sent 20 investigators to the two farms -- Wright County Egg and Hillandale Farms, said 26 August 2010 that it had detected the particular strain of Salmonella in two barns at Wright County Egg and in feed that the company made and gave to its own chickens. The agency also found that strain in feed that Wright supplied to Hillandale.

These are the very first results that we're beginning to get in, and there are many other results in the queue that may give us clues as to the extent of contamination," said Jeff Farrar, associate commissioner for food protection at the FDA. He said that the agency had taken 600 samples at the farms for laboratory analysis and that additional results were expected.

Officials from Wright County Egg said in a statement that the presence of Salmonella on the property did not necessarily mean that the eggs were infected. But the company also pledged to work with the FDA.


USA: FDA reports show biosecurity gaps at two egg farms
Federal officials 31 August 2010 released their initial inspection reports of the two Iowa companies linked to the nation's biggest egg recall, which reveal multiple biosecurity breaches, such as rodent infestation, wild birds in poultry barns, and instances in which chicken manure could have contaminated egg-laying areas.

The inspections—which represent the nation's first under the new shell egg safety rules—revealed that both companies failed to follow and implement their written Salmonella Enteritidis (SE) prevention programs. The national SE outbreak has sickened nearly 1,500 people so far and led to the recall of about 550 million eggs.

Details of the inspections appear on US Food and Drug Administration (FDA) 483 forms, which officials said don't cover all of the findings but focus on the ones that amount to violations of the FDA's new egg safety rules, which went into effect for the nation's largest producers in July 2010. At a news conference 31 August 2010, David Elder, director of the FDA's Office of Regulatory Affairs, said the 483 forms show "significant objectionable conditions."

Investigators were at Wright County Egg facilities from 12-30 August 2010 exploring conditions at five sites and at the company's feed mill operation. Elder said.

Live mice were found inside laying houses at four sites, and numerous live and dead flies were observed in egg-laying houses at three locations. Evidence of wild birds, including pigeons, was found at two locations.

Chicken manure accumulated four to eight feet high underneath the cages at two locations. The weight of the manure at the two locations pushed out access doors, allowing open access for wildlife and other farm animals. At one location, uncaged birds were using tall manure piles to access egg-laying areas.

The federal inspectors also saw employees not changing or not wearing protective clothing when moving from laying house to laying house.

At Wright County Egg's feed mill, evidence of wild birds was noted in the milling, mixing system, and storage areas. Raw-ingredient bins had holes open to the environment, with evidence of pigeons near the openings.

Meanwhile, the inspection at three Hillandale Farms locations revealed unsealed rodent holes with evidence of live rodents at one of the facilities, with gaps in walls and doors at other sites. Standing water was observed near a manure pit at one of the locations, and liquid manure leaks were noted at two sites. As at Wright County Egg, uncaged chickens were observed tracking manure into the caged hen areas.

Employees at one of the company's sites didn't document that 19-week-old pullets were raised under SE-monitored conditions.

Dr Jeff Farrar, associate commissioner of food protection in the FDA's Office of Foods, told reporters that the FDA received one more positive SE lab result that matches the outbreak strain from spent egg wash water from a facility at Hillandale Farms.

Federal officials didn't comment on what further action they may take, which could include seizure, injunction, or even criminal prosecution, based on the inspection findings.

Dr Michael Taylor, the FDA's deputy commissioner for foods, told reporters that though the FDA has no reason to believe the practices that investigators turned up are common at all egg-producing facilities, inspectors will be inspecting about 600 large egg producers, those that have 50,000 or more laying hens, over the next several months starting in September 2010 with what it believes may be the highest-risk facilities.

As a component of the new egg rules, the egg inspections were planned before the outbreak and recall occurred. However, Taylor said the experiences gained at Wright County Egg and Hillandale Farms will help guide FDA inspectors as they make their inspection rounds of other farms over the next 15 months.

We think individual compliance will reduce the risk, but it's our job to see that it happens, he said.

David A. Halvorson, DVM, an avian health authority at the University of Minnesota who is an expert on biosecurity and food safety, said he had read the FDA's inspection reports and didn't want to comment directly on the investigation, given the likelihood of future litigation related to the outbreak and recall.

But he did say that egg-producer inspections represent new ground for FDA inspectors. They will likely expect egg farms to pass inspections suitable for food or drug establishments. Passing the inspection is apparently not based on freedom from SE, but compliance with an SE-prevention plan, he said.

So far it is not clear if SE has been detected in the eggs, Halvorson said, adding that the FDA requires egg testing to be completed by 10 days after the detection of a positive environmental sample. So it's possible the egg testing is complete and the results were negative, he said.

The food safety watchdog Center for Science in the Public Interest (CSPI) 31 August 2010 called the FDA's 483 inspection report "stomach churning." Caroline Smith DeWaal, the CSPI's food safety director, said, that equally troubling is that the inspections occurred the month following the date that the new egg-safety regulation went into effect. Both companies involved had been on notice that they needed to meet requirements of the new egg-safety rule for over a year.

The "decrepit" conditions in the hen houses suggests that the companies assumed that FDA inspections are so rare, despite the new egg safety rules, that they saw no urgency to fix their buildings to ensure compliance with the new requirements, DeWaal said.

In other developments, Sparboe Farms, based in Lichfield, Minn., recalled eggs that it received from both Wright County Egg and Hillandale Farms. The eggs were distributed to grocery stores and foodservice companies in Colorado, Iowa, Illinois, Kansas, Nebraska, Wyoming, North Dakota, South Dakota, Montana, and Minnesota under the following five brand names: Albertson, Sparboe Farms, Liborio Market, Shamrock Foods, and Glenview Farms.

Eggs subject to the recall include large 6-egg to 30-dozen bulk cases of eggs that were produced on 2, 3, and 7 August 2010. The recall also applies to extra-large eggs packed in 12-dozen cartons that were produced between 30 July and 6 August 2010.
(CIDRAP 08/31/2010)


USA (California): Program effective against Salmonella in eggs
Many large egg producers in California have essentially eliminated Salmonella on their farms by following a state-sanctioned quality assurance program that includes vaccinating hens and testing barns regularly. But only nine other states have adopted similar government-sponsored prevention programs, in part because they make eggs more expensive, putting producers at a competitive disadvantage. It adds that producers in states like Iowa—the site of farms that have recalled more than 500 million eggs because of a Salmonella Enteritidis outbreak—have lower production costs than California producers participating in the safety program. The Food and Drug Administration (FDA) egg safety rules that took effect for large farms in July 2010 do not require Salmonella vaccination for chickens, because FDA officials concluded there was too little evidence that Salmonella vaccines are effective.
(CIDRAP 09/01/2010)


USA (Illinois): TB outbreak being contained
Health authorities are reporting progress in containing a tuberculosis outbreak in Kane County, west of Chicago.

No active cases have occurred since late June 2010 and none turned up in a mass screening in August 2010. Almost 200 people were tested then.

So far, 17 active cases have been identified since the outbreak began earlier in 2010. Most involve residents of a homeless shelter in Aurora and close contacts. Another mass screening is planned in October.

Kane County Health Department spokesman Tom Schlueter says authorities have been aggressively screening and educating homeless shelter residents about TB.
(CBS2 Chicago 09/01/2010)


USA: National pertussis report
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.

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 2010 to 33 between 27 June and 3 July 2010, 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 8 in 2008, according to Public Health.

According to a report from Dr Joshua Meyerson, the medical director of the Health Department of Northwest Michigan, 25 cases of pertussis have been discovered in the four counties, Antrim, Charlevoix, Emmet, and Otsego, served by Northwest. The outbreak is five times the typical number. There have been cases so far in Otsego County in 2010, a child and an adult.

Meyerson states that 10-15 percent of children have not been vaccinated. In some ways these vaccinations are victims of the initial success of the vaccine, said Jane Sundmacher, public information officer of Northwest. Before the vaccine was introduced in the 1940s, pertussis was the major cause of serious illness and death in infants and young children.

The alarm being sounded about the outbreak is particularly important in Michigan. California and Michigan lead the country in the percentage of children not vaccinated. California has suffered 10 deaths and Michigan one.

Wendy Phillips, public information officer of Northeast Health Department, reports there have been no identified cases of pertussis in 2010 in Montmorency County. There are, however, two cases in both Alpena and Cheboygan, and the two in Otsego suggests it's only a matter of time before it spreads to Montmorency.

Missouri has reported 82 confirmed cases of pertussis in the last month. One-quarter of those involved infants under a year old.

A rise in reported cases of pertussis in causing concern in the greater Philadelphia area, health officials say. The suburban counties of southeastern Pennsylvania have witnessed increased occurrences of the infection, which can be fatal in infants. Delaware County saw the largest increase in cases, jumping from five cases to 44 within a three-month period.

The second highest increase in whooping cough cases was in Montgomery County, where 39 new cases were tallied between April and June 2010, compared to eight new cases in the three months preceding.

A Grant County baby has died from whooping cough and another is recovering from the highly contagious bacterial disease, Grant County health officials say.

The infant died Tuesday night, 24 August 2010, at Children's Hospital and Medical Center in Seattle, Washington, according to Theresa Fuller, public information officer for the Grant County Health District. The other child is recovering at home. There appears to be no connection between the cases, she said.

Health officials are working with health-care providers of children and adults who may have been exposed to the sick children, Fuller said. In some cases, those people may need antibiotics.

According to the CDC, 8,000 to 25,000 cases of pertussis, are reported each year in the USA.

During the last decade, pertussis has re-emerged as one of the most pressing public health issues due to increasing numbers of cases and lower vaccination rates, Fuller said.

Recently, multiple outbreaks of pertussis have been investigated in the USA, including cases in California and Idaho, said Jeff Ketchel, health district administrator. From 2005 to 2009, Washington state had 2636 cases of whooping cough. During this same time period, Grant County had 17 cases.

About one in 20 infants with pertussis get pneumonia, said Dr Alexander Brzezny, Grant County health officer. About one in 100 infants will have convulsions. In rare cases, pertussis can be deadly, especially in infants under one year old. Nearly all infants with pertussis get the infection from an infected adult.
(ProMED 08/27/2010)


USA: Federal contract supports more work on adjuvanted anthrax vaccine
Emergent BioSolutions Inc. 1 September 2010 announced it has won a federal contract worth up to $28.7 million for further development of its "third generation" anthrax vaccine, consisting of the existing product, BioThrax (anthrax vaccine adsorbed), combined with a novel adjuvant called CPG 7909. BioThrax is the only US-licensed anthrax vaccine and is used by the US military. The company said the contract from the National Institute of Allergy and Infectious Diseases (NIAID) includes a two-year base award valued at $9.1 million, plus milestone-based options that, if exercised, would increase the total value to $28.7 million. The base contract provides for manufacturing and stability studies of vaccine for phase two clinical trials, process characterization and assay validation, and clinical trial preparation. The milestone-based options cover further stability testing and a clinical study of the vaccine's safety and immunogenicity. The phase two study is expected to begin early in 2012, with preliminary data due later in the year. The new contract is a sequel to a $29.7 million deal that was awarded by NIAID and the federal Biomedical Advanced Research and Development Authority (BARDA) in September 2008.
(CIDRAP 09/01/2010)


USA: Production problems decrease smallpox vaccine delivery to US
Bavarian Nordic will deliver only about two million doses of its non-replicating smallpox vaccine, Imvamune, to the US government in 2010 instead of the four million to five million doses that were planned previously, the Danish biotechnology firm said. The company said "technical issues" have delayed the scaling up of Imvamune production, but the problems have been identified and corrective actions taken. The 18 million remaining doses under the firm's $500 million contract with the US government will be delivered from 2011 through 2013, officials said. The company began increasing production after it received delivery clearance from the Food and Drug Administration earlier in 2010. Imvamune is intended for use in people who have weakened immunity or other contraindications to conventional smallpox vaccine, which uses a replicating strain of vaccinia virus, a close relative of the smallpox virus. The US government previously stockpiled hundreds of millions of doses of the conventional vaccine for use in case of a smallpox attack by bioterrorists.
(CIDRAP 08/31/2010)


3. Updates
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
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 115:

CDC Teleconference results: Healthcare groups need to share emergency plans:

American Academy of Pediatrics Policy Statement: Recommendations for Prevention and Control of Influenza in Children, 2010-2011: http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-2216v1


- 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.


Health authorities say far north Queensland is heading for a record number of imported cases of dengue fever. There are two active outbreaks -- one in the Cairns CBD [central business district] and another at Mount Sheridan, just south of the city.

Tropical Regional Services spokesman Brad McCulloch says he is concerned about the high number of Aedes aegypti mosquitoes breeding in some Cairns suburbs. The mosquito is responsible for carrying dengue virus.

We're tracking for a record number of imports in 2010-- we've had, I believe, 27 imports already this year, he said. He said that their annual record for a year is 28. They are seeing an increased number of imported cases of dengue as it becomes more and more prevalent across the tropical world. Obviously having a high base number of mosquitoes present in the community provides an opportunity then for those imported cases to go on and infect other people, McCulloch said.

[ProMED note: This report is confusing. It indicates that there are two active outbreaks, yet the health official is quoted as being concerned about imported cases with out comment about ongoing local transmission. If there are locally acquired cases, it would be of interest to know when the outbreak began and how many cases have occurred.]
(ProMED 08/26/2010)

Chinese Taipei
The Taipei City Department of Health on Tuesday 24 August 2010 announced the first reported case of indigenous dengue fever in the city for two years. The department does not yet know how the patient, who has not recently traveled out of the country or even Taipei City, was infected with the mosquito-born virus, the officials added. So far in 2010, 31 cases of confirmed dengue fever infection were reported in Taipei City, 30 of which were determined to be imported cases, the department said.

Citing data from the Taiwan Centers for Disease Control (CDC) under the Department of Health, the officials said dengue fever cases in Taiwan occurred earlier than usual in 2010 due to global warming that led to a suitable climate for mosquito breeding. According to CDC statistics, the number of recorded indigenous dengue fever cases in the country has risen to 30 since March, mostly in Taiwan's southern areas of Kaohsiung and Tainan. CDC Deputy Director-General Chou Chih-hao warned that as 18 of the cases were reported the week of 16 Aug 2010, it appeared that the outbreak was accelerating.

Recently, temperatures in Taiwan have hovered around 25-30 deg C [77-86 deg F]. With afternoon showers common in the summer, it is easy for the mosquitoes that can spread dengue fever to reproduce if people allow stagnant water to remain in containers, Chou said.
(ProMED 08/30/2010)

India (Delhi)
Dengue cases increased alarmingly in the national capital as 59 more patients tested positive for the vector-borne virus, taking the total number of people being affected by it to 800. The national capital has recorded two confirmed and three suspected dengue deaths in 2010.

The MCD [Municipal Corporation of Delhi] said it has deployed additional staff to tackle the situation in the worst-hit Central and South Delhi, from where 271 cases have been reported so far. It is also maintaining round-the-clock surveillance near all the Commonwealth Games venues, municipal commissioner KS Mehra said.

[ProMED note: The 23 August 2010 edition of News-Views reported on Delhi's efforts to reduce Aedes aegypti breeding sites. The report stated that the MCD has issued 45,532 legal notices against owners of property where water stagnation was found. A total of 6,125 persons have been prosecuted. Mosquito breeding has been detected in 44,743 houses in various parts of the city. Other reports indicate that city officials are concerned about dengue virus transmission continuing into October 2010 when the Commonwealth Games will be held in Delhi.]
(ProMED 08/30/2010)

India (Orissa)
At least seven persons died and about 50 others were affected in an outbreak of dengue in Orissa's tribal-dominated Malkangiri district in the past three weeks, official sources said 27 August 2010. The deaths were reported from Padia, MV-67, and Materu villages under Padia block of the district during the period, chief district medical officer (CDMO) Rabindra Kumar Nath said adding five of the deaths took place in last week alone.

Though most of the patients, showing symptoms of high fever, had undergone treatment at the local primary health centre (PHC) initially, several had to be shifted to Visakhapatnam in neighboring Andhra Pradesh later, he said. Blood tests of the patients at Visakhapatnam detected dengue, Nath said, adding about 50 persons suffering from the disease were currently undergoing treatment at various hospitals and health authorities took steps to deal with the situation.

A team of experts and doctors visited the affected areas to ensure proper treatment of patients besides taking preventive steps against the disease through mosquito control, sources said. An awareness drive has also been launched to check spread of the disease.
(ProMED 08/30/2010)

India (Uttar Pradesh)
At least 215 people, mostly children, have died in an outbreak of Japanese encephalitis in an impoverished region of northern Indian and the death toll is likely to soar, officials said Saturday 28 August 2010. Eastern parts of India's most populous state Uttar Pradesh are ravaged by encephalitis each year, but this is one of the worst outbreaks, officials said.

In Gorakhpur, four more people have died of encephalitis, taking the number of victims claimed by the disease in Uttar Pradesh's eastern region in 2010 to 219, a health official said 31 August 2010.

The dead included one each from Gorakhpur, Deoria and Kushinagar districts of UP and one from neighboring state Bihar, he said. Meanwhile, 45 new encephalitis patients have been admitted in different hospitals of the region.

Out of a total of 219 deaths due to the disease this year, 208 occurred at BRD Medical College Hospital alone, he said.

The deaths of four more children on 28 August 2010 pushed the toll to 215, with hundreds sick in hospitals in Gorakhpur, an area of 14 million people, regional health officer UK Srivastava said. A total of 1324 patients had been admitted in hospitals until Saturday in Gorakhpur, which is the epicenter of the outbreak, and more encephalitis patients are coming into our hospitals, Srivastava said.

The outbreak began in early July 2010. We fear the total number of encephalitis cases will go up to at least 3500 and the death rate will be at a ratio of around 20 percent, he said.
We have begun spraying insecticide to wipe out populations of the Culex mosquitoes which transmits the virus and we're handing out chlorine to villagers to disinfect drinking water supplies, Srivastava said.

KP Kushwaha, chief pediatrician at Gorakhpur's BRD Medical College, said doctors were overwhelmed, and that encephalitis usually surfaces by August but in the 2010 season patients began coming in from early July, and if it continues this is going to be an impossible task to handle, he added.

VS Nigam, in charge of Uttar Pradesh's encephalitis prevention program, said a mammoth project to contain the disease had ended with 35 million children vaccinated in the state's 34 districts. But as soon children are vaccinated against Japanese encephalitis, they fall sick with acute encephalitis syndrome because when one virus is suppressed by vaccines, others become dominant, he said. It's a large challenge, he added.

The regional chapter of the Voluntary Health Association, India's largest non-governmental organization, which works alongside the UN Children's Fund (UNICEF), blamed the annual tragedy on the state's failure to effectively immunize children. A high alert is sounded only after an encephalitis epidemic flares, association executive director JP Sharma said. Preventive steps should be taken well ahead of the monsoon as vaccines need an incubation period to make human beings immune to the virus, Sharma said.
(ProMED 8/28/2010, 8/31/2010)

Mexico (Nayarit)
The director of Municipal Health, Alejandro Hernandez Suzawa, reported that in the Santiago Ixcuintla municipality, two people died from DHF and 76 residents of this area have the disease: 37 with classical dengue fever and 39 with DHF. He added that the constant rains in the region has been a factor that favored rapid reproduction of the Aedes aegypti mosquito.

[ProMED note: This is an extraordinarily high ratio of DHF to dengue fever cases, which would be expected to be around 10 percent DHF cases or less.]
(ProMED 8/30/2010)

Peru (Piura)
The Piura Regional Health Directorate (DIRESA) Piura has reported a total of 8,166 medical visits for dengue up to epidemiological week 30 [25-31 July 2010]. The districts with greatest dengue risk are Salitral (260), Castilla (170), Morropon (143), Bellavista (129), and Piura (116) per 100,000 population.
(ProMED 08/30/2010)

The number of dengue cases in the country continues to surge with the figure already nearing 55,000 based on the figures released by the Department of Health (DOH)-National Epidemiology Center (NEC) Tuesday, 24 August 2010. In its Disease Surveillance Report from the period of 1 January-14 August 2010, the NEC noted that there are now 54,659 cases reported in hospitals in the Philippines. This is 74.9 percent higher compared to the same time period in 2009, which was only at 31,248. The deaths due to dengue were also higher with 429 recorded compared to the 327 in 2009 during the same period.

The DOH had repeatedly stressed that the most effective way to fight dengue is by practicing their 4-S strategy -- Search and destroy, Self-protective measures, Seek early treatment and Say, no to indiscriminate fogging.
(ProMED 08/30/2010)

Philippines (Negros Occidental)
Negros Occidental [Western Visayas] governor Alfredo Maranon Jr told the chief executives of eight towns and cities whose number of dengue cases is already within the outbreak level to take drastic measures to address the problem.

Dr Ernell Tumimbang, officer-in-charge of the Provincial Health Office (PHO), identified the "dengue hotspot" barangays [barrio, the smallest administrative division in the Philippines]. Dengue cases in these areas have been steadily increasing for the past four weeks, Tumimbang noted. The latest records at the PHO showed that 20 Negrenses died of dengue while the number of cases went up to 2872 for the period of January to 7 August in 2010, compared to only 671 cases with 13 recorded fatalities during the same period in 2009.
(ProMED 08/26/2010)

Philippines (Zamboanga)
Officials have declared a dengue fever outbreak with the increase in number of people being afflicted by the mosquito-borne virus. August 2010 has not even ended yet but figures from the Zamboanga health office showed that 314 dengue fever cases have been registered since the start of the month. The city health office said 20 patients in this city have died of the disease since January 2010. Dr Rodelin Agbulos, city health officer, said from January-24 August 2010, a total of 1,584 dengue cases had been reported. He said half of the city's 20 villages were responsible for the surge in dengue cases. Mayor Celso Lobregat said the city government has decided to resort to fumigation to control the spread of the disease.

Health workers have been conducting dialogues with residents on how to clean up their surroundings to prevent the breeding of dengue-causing mosquitoes. Other preventive measures have been undertaken by providing public schools, situated in so-called endemic areas, with anti-mosquito-treated curtains. Parents were also advised to ensure that their school children were protected by insect repellent lotion and enjoin them to wear long pants and long sleeved-shirts when possible.
(ProMED 08/30/2010)

Russia (Volgograd, Rostov)
The head public health physician of the Russian Federation has provided information about six fatal cases of West Nile virus in 2010. Five of these cases were in Volgograd oblast [region] and one in Rostov oblast. The doctor mentioned the abnormally hot weather as a cause of the high number of cases this year. The heat facilitated the growth of the mosquito population, which are the vectors of this virus.

There have been 160 West Nile virus confirmed cases in 2010 over all Russia. The majority of infections happened in Volgograd oblast, 107 out of 160. He also mentioned that the cases tend to be individuals of older ages who get the infection during trips to their dachas [cottage houses] outside of the cities. Anti mosquito measures are being carried out.
(ProMED 08/30/2010)

A total of seven people died from dengue fever the week of 16 August 2010, bringing the nationwide toll from the disease to 70 deaths out of some 60,000 dengue fever patients in 2010, Public health minister Jurin Laksanawisit said 23 August 2010.

Two of the dengue fever deaths the week of 16 August 2010 were in Krabi, while Chiang Rai, Phetchabun, Lop Buri, Chachoengsao, and Nakhon Si Thammarat reported one death each. As the dengue fever outbreak is so severe in 2010, Jurin has instructed all provincial health chiefs to monitor and control the disease as well as urging people with suspicious symptoms of dengue fever to see doctors immediately.

The situation so far in 2010 is 83 per cent higher than in 2009, with an average of 230 new cases detected per day.

The Southern region had 14,361 cases, Northern region 8,843 cases, Central region 15,871 cases, and Northeastern region 15,517 cases. Of these, seven patients were less than 28 days old, and 409 cases were over 65 years.
(ProMED 08/30/2010)

United States (Massachuesetts)
The Department of Public Health (DPH) 27 August 2010 announced the first case of eastern equine encephalitis (EEE) in Massachusetts residents. The case is a 43-year-old man from Plymouth County who has been diagnosed with eastern equine encephalitis (EEE). The patient developed symptoms on 21 August 2010, was hospitalized on 23 August 2010, and remains hospitalized. His exposure to a mosquito infected with EEE virus likely occurred in the southeastern section of Massachusetts, which has been identified as an area of elevated risk for mosquito-borne illness. Aerial spraying has been conducted in Plymouth County.

There were no human cases of EEE during 2009; however there were 13 cases with six deaths from 2004 through 2006. EEE virus is usually spread to humans through the bite of an infected mosquito with symptoms beginning five to seven days later. EEE is a serious disease in all ages and can even cause death.

Every year, we always hope that there won't be any cases of either of these mosquito-borne illnesses, said DPH State Epidemiologist Dr Alfred DeMaria. People have an important role to play in protecting themselves and their loved ones from illnesses caused by mosquitoes.

This is the second human case of EEEV attributed to the area. The first person lives in RI but had travel history to the area.

This is the usual season for transmission of EEE virus, which is likely to continue until the onset of killing frosts. A commercial vaccine is available for horses but not for humans, so prevention of mosquito bites is the only preventive measure that individuals can take.
(ProMED 08/30/2010)

USA (Michigan)
A third human case of the deadly Eastern equine encephalitis (EEE) was confirmed 23 August 2010 by the Michigan Department of Community Health. EEE is a mosquito-borne virus disease spread like the West Nile virus. The week of 16 August 2010, two human cases were reported in Kalamazoo County.
(ProMED 08/24/2010)

Viet Nam
The central highlands province of Kon Tum said last 26 August 2010 it had recorded over 600 patients infected with dengue, one of whom succumbed to the disease. The provincial Preventive Health Center announced that the fever had spread to nine districts so far.

The Central Highlands Institute of Epidemic Prevention has supplied Gia Lai with 500 liters of chemicals to spray areas with mosquito larvae.

In 2010, 1,456 people have contracted dengue fever in Da Nang Province, an increase of six times compared to the same period in 2009, and one person has died.

In Phu Yen Province, dengue fever has been recorded in 27 out of 114 communes. Dr Nguyen Thanh Truc, deputy director of the Phu Yen Department Health said the province had recorded 2,380 cases of dengue fever as of 17 August 2010. Provincial authorities had announced three days earlier that the fever had spread across the province.
(ProMED 08/30/2010)


China (Anhui)
An outbreak of cholera, suspected to be caused by contaminated food, sickened 30 people in Mengcheng County of east China's Anhui Province over two weeks, local health officials reported 28 August 2010.

20 of the patients remain hospitalized as of 28 August 2010, with most exhibiting symptoms that include vomiting and diarrhea, said officials with the Anhui provincial health bureau.
(ProMED 08/31/2010)

China (Hong Kong)
The Center for Health Protection (CHP) of the Department of Health 25 August 2010 is investigating another confirmed cases of cholera and reminds people to observe good personal, food, and environmental hygiene, whether in Hong Kong or traveling abroad.

The case involved another 30-year-old woman who developed diarrhea and vomiting on 22 August 2010. The patient lives in Tsing Yi and did not have history of recent travel. Her home contact has no symptoms of cholera.

The patient has been admitted to Princess Margaret Hospital and is in stable condition. Laboratory tests showed that stool specimens yielded positive result for Vibrio cholerae O1 Ogawa.

This is the eighth 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 08/26/2010)

India (Haryana)
More than 43 cases of typhoid have been reported in the week beginning 23 August 2010 at General Hospital, Sector Six, forcing them to gear up to handle the situation.

These cases have been reported from urban as well as rural areas, and the figures are on similar lines as the previous week's, when about 45 cases of typhoid had surfaced.

Diarrhea too is on the rise, as nearly 40 cases have been reported from 26 -29 August 2010 alone. Doctors blame it on rains and contamination of water. As a combat measure, the hospital has decided to crack down on colonies, which they claim are the breeding grounds for these diseases. Teams of health officials have been visiting various colonies every fortnight to assess the situation. The main colonies, including Rajiv, Indira and Azad Colony [slums in the city of Panchkula], are the ones that the hospital is keeping a close watch on.
(ProMED 08/29/2010)

India (Jammu and Kashimir)
With more than 2000 people affected by diarrhea epidemic in mountainous districts of Doda and Ramban, Jammu and Kashmir government have geared up with army help to tackle the situation as more than 1,700 people have so far been admitted in the hospitals.

As many as 2047 diarrhea patients have been identified in several remote and mountainous areas of Doda and Ramban districts by the teams of doctors to date, state health department officials said 30 Aug 2010.

Of these, 1,347 patients were identified in Doda and 700 in Ramban district, they said adding 1,747 have been admitted in Doda and Banihal hospitals and the rest were treated in their hamlets by the teams of doctors from the army and state health department.

So far, three people have died due to the disease in past nine days in Doda, they said, adding 16 people have been shifted to the hospital in Jammu for specialized treatment.
(ProMED 08/30/2010)


4. Articles
Flutracking provides a measure of field influenza vaccine effectiveness, Australia, 2007–2009
Carlson SJ, Durrheim DN, Dalton CB. Vaccine. 21 August 2010. doi:10.1016/j.vaccine.2010.08.051.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50V00XS-8&_user=10&_coverDate=08%2F21%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1157e71656076641047a7173e5ea604c&searchtype=a

Abstract. We reviewed Flutracking's (an Australian weekly online survey of community members) performance in estimating influenza vaccine effectiveness using New South Wales data for participants aged 18–60 years of age from 2007, 2008 and 2009. Flutracking results were consistent with previous findings that the 2009 seasonal influenza vaccine was ineffective in preventing the dominant pH1N109 strain of influenza, and that 2007 and 2008 vaccine strains were considered well matched to the circulating virus in Australia. Flutracking may offer an opportunity to estimate real time vaccine effectiveness during an influenza season.


Universal Influenza Vaccination: An Optimal Goal—But How and When?
Henderson DA. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 25 August 2010 -Not available-, ahead of print. doi:10.1089/bsp.2010.0816.
Available at http://www.liebertonline.com/doi/abs/10.1089/bsp.2010.0816

Introduction. On June 29, 2010, The Advisory Committee on Immunization Practices approved detailed recommendations for the future use of influenza vaccines for preventing and controlling influenza. A significant change was the recommendation for “annual influenza vaccination to included all people aged 6 months and older.” Past recommendations had focused on priority vaccination for an ever-increasing number of groups of people with “risk factors for influenza-related complication or having close contact with a person at high risk for influenza-related complications.” By 2009, the ever-growing list of risk groups accounted for 85% of the total population. The only group for whom routine vaccination was not then recommended were health, nonpregnant adults aged 18 to 49 years who did not have an occupational risk for infection and who were not close contacts of people at special risk of experiencing complications. Thus, to recommend vaccination for everyone was a logical simplification of long-standing recommendations. There is no question but that there is a benefit from vaccine protection against possible influenza infection, while the risks of adverse reactions to the vaccine are negligible. The conclusion is obvious-but how does this recommendation rank among the long list of public health problems demanding attention? No guidance has been provided


Influenza Vaccination of Household Contacts of Newborns: A Hospital‐Based Strategy to Increase Vaccination Rates
Walter EB, Allred NJ, Swamy GK, et al. Infect Control Hosp Epidemiol. 30 August 2010;31:1070-1073.doi: 10.1086/656563.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/656563

Abstract. We implemented a hospital‐based influenza vaccination program for household contacts of newborns. Among mothers not vaccinated prenatally, 44.7% were vaccinated through the program, as were 25.7% of fathers. A hospital‐based program provided opportunities for vaccination of household contacts of newborns, thereby facilitating better adherence to national vaccination guidelines.


Results of a National Survey of Infectious Diseases Specialists regarding Influenza Vaccination Programs for Healthcare Workers
Polgree PM, Septimus E, Talbot TR, et al. Infect Control Hosp Epidemiol. 30 August 2010;31:1063-1065.doi: 10.1086/656382.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/656382

Abstract. A minority of infectious diseases consultants currently work in healthcare institutions requiring influenza vaccination for healthcare workers, and in approximately half of these institutions, the healthcare workers who refuse vaccination do not face substantial consequences for their refusal. Although true mandatory policies are not common, a majority of infectious diseases consultants support such policies.


Knowledge and attitudes regarding influenza vaccination among nurses: A research review
Zhang J, While AE, Norman IJ. Vaccine. 30 August 2010.doi:10.1016/j.vaccine.2010.08.065.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50WYGH2-1&_user=10&_coverDate=08%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f515bbd786996a05b2704ba49bbdf4eb&searchtype=a

Introduction. Influenza vaccination rates among nurses remain suboptimal despite health authority recommendations in many countries and several vaccination campaign programmes to encourage nurses to be vaccinated in many institutions. We reviewed published studies investigating nurses’ knowledge and attitudes towards influenza vaccination to establish what is known about the determinants of nurses’ influenza vaccination practices.

Methods. Relevant articles published up to July 2010 were identified through multiple databases (CINAHL, MEDLINE, PubMed, EMBASE, BNI, HMIC, PsycINFO, CMAC, and CNJ) using predetermined search strategies. Review of the titles and abstracts revealed 182 of 254 references were not relevant. Of 45 full papers reviewed, 32 did not report nurse data separately and one was a duplicate report of a study.

Results. We included 12 research studies which had investigated the relationship between knowledge and attitudes towards influenza vaccination and nurses’ vaccination practices published between 2003 and 2010. All the studies were descriptive and relied upon self-report data. The findings of this review indicate a relationship between knowledge, attitudes and vaccination practices of nurses. There were three main findings: first, there was a strong association between nurses’ knowledge of influenza and vaccination and their vaccination status; second, the surveys showed a positive relationship between perceptions of influenza as a serious illness and vaccination as effective and safe and a positive vaccination status; and third, there was a relationship between nurses’ vaccination status and their reported promotion of vaccination to their patients.

Conclusion. This review indicates that higher knowledge and positive attitudes towards influenza vaccination have a significantly positive association with vaccination coverage among nurses. Further studies are needed to identify influences on nurses’ attitudes and practices regarding influenza vaccination and the personal, organizational, and situational factors that influence the uptake of influenza vaccine by nurses.


Safety of MF59-adjuvanted versus non-adjuvanted influenza vaccines in children and adolescents: An integrated analysis
Black S, Della Cioppa G, Malfroot A, et al. Vaccine. 31 August 2010.doi:10.1016/j.vaccine.2010.08.075.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50X8G9M-1&_user=10&_coverDate=08%2F31%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a4bcd8cb779ac97aa5bb97867d46adc4&searchtype=a

Abstract. We reviewed the safety of MF59-adjuvanted versus non-adjuvanted influenza vaccines in children and adolescents (aged 6 months–18 years) in an integrated analysis of all pediatric trials evaluating MF59-containing influenza vaccines completed to date (5 trials). In the MF59-adjuvanted group (n = 1181) versus the non-adjuvanted group (n = 545) there was no increase in the incidence of unsolicited adverse events and serious adverse events. As expected, solicited local or systemic reactions occurred more frequently in MF59-adjuvanted subjects; however, a majority of reactions were mild and transient. These data support the safety of MF59-adjuvanted influenza vaccines in the pediatric population.


Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel
Talbot TR, Babcock H, Caplan AL, et al. Infect Control Hosp Epidemiol. 31 August 2010. doi:10.1086/656558.
Available at http://www.journals.uchicago.edu/doi/full/10.1086/656558

Executive Summary. This document serves as an update and companion piece to the 2005 Society for Healthcare Epidemiology of America (SHEA) Position Paper entitled “Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages.”1 In large part, the discussion about the rationale for influenza vaccination of healthcare personnel (HCP), the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA’s position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper1 still serves as the Society’s official statement on that issue.


Hospital Discharge Data for Guillain-Barre Syndrome and Influenza A (H1N1) Vaccine Adverse Events
Jones TF, McMillian M, Booth E, et al. Emerg Infect Dis. September 2010. doi: 10.3201/eid1609.091837.
Available at http://www.cdc.gov/eid/content/16/9/1500.htm#cit

To the Editor. As part of the public health response to the current pandemic (H1N1) 2009, surveillance for adverse events following vaccination for influenza A (H1N1) is a high priority (1). Surveillance for Guillain-Barre syndrome (GBS) has been of particular interest, because the syndrome was associated with the 1976–1977 swine influenza vaccine (1,2). To study this association, reliable ascertainment of recent incident cases of GBS is necessary.


Facial Protective Equipment, Personnel, and Pandemics: Impact of the Pandemic (H1N1) 2009 Virus on Personnel and Use of Facial Protective Equipment
Murray M, Grant J, Bryce E, et al. Infect Control Hosp Epidemiol. 23 August 2010. doi: 10.1086/656564.
Available at http://www.journals.uchicago.edu/doi/abs/10.1086/656564

Background. Before the emergence of the pandemic (H1N1) 2009 virus, estimates of the stockpiles of facial protective equipment (FPE) and the impact that information had on personnel during a pandemic varied.

Objective. To describe the impact of H1N1 on FPE use and hospital employee absenteeism.

Setting. One tertiary care hospital and 2 community hospitals in the Vancouver Coastal Health (VCH) region, Vancouver, Canada.

Patients. All persons with influenza‐like illness admitted to the 3 VCH facilities during the period from June 28 through December 19, 2009.

Methods. Data on patients and on FPE use were recorded prospectively. Data on salaried employee absenteeism were recorded during the period from August 1 through December 19, 2009.

Results. During the study period, 865 patients with influenza‐like illness were admitted to the 3 VCH facilities. Of these patients, 149 (17.2%) had laboratory‐confirmed H1N1 influenza infection. The mean duration of hospital stay for these patients was 8.9 days, and the mean duration of intensive care unit stay was 9.2 days. A total of 134,281 masks and 173,145 N95 respirators (hereafter referred to as respirators) were used during the 24‐week epidemic, double the weekly use of both items, compared with the previous influenza season. A ratio of 3 masks to 4 respirators was observed. Use of disposable eyewear doubled. Absenteeism mirrored the community epidemiologic curve, with a 260% increase in sick calls at the epidemic peak, compared with the nadir.

Conclusion. Overall, FPE use more than doubled, compared with the previous influenza season, with respirator use exceeding literature estimates. A significant proportion of FPE resources were used while managing suspected cases. Planners should prepare for at least a doubling in mask and respirator use, and a 3.6‐fold increase in staff sick calls.


Hospitalized adult patients with 2009 influenza A(H1N1) in Beijing, China: risk factors for hospital mortality
Xiuming X, Yuan X, Li J, et al. BMC Infectious Diseases. 27 August 2010. 10:256. doi:10.1186/1471-2334-10-256.
Available at http://www.biomedcentral.com/1471-2334/10/256

Background. In April 2009, the pandemic influenza A(H1N1) virus emerged and spread globally. The objective of this study was to describe the independent risk factors for hospital mortality and the treatment effect of corticosteroids among patients with 2009 influenza A(H1N1) infection.

Methods. We retrospectively obtained clinical data of 155 adult patients with confirmed infection of 2009 influenza A(H1N1) in 23 hospitals in Beijing, China from October 1 to December 23, 2009. Risk factors for hospital mortality were identified with multivariate logistic regression analysis.

Result. Among the 155 patients, 90 (58.1%) were male, and mean age was 43.0+/-18.6 years, and comorbidities were present in 81 (52.3%) patients. The most common organ dysfunctions included acute respiratory failure, altered mental status, septic shock, and acute renal failure. Oseltamivir was initiated in 125 patients (80.6%), only 16 patients received antiviral therapy within 48 hours after symptom onset. Fifty-two patients (33.5%) were treated with systematic corticosteroids, with a median daily dose of 80 mg. Twenty-seven patients (17.4%) died during hospital stay. Diabetes [odds ratio (OR) 8.830, 95% confidence interval [CI] 2.041 to 38.201, p = 0.004) and lactate dehydrogenase (LDH) level (OR 1.002, 95% CI 1.000 to 1.004, p = 0.027) were independent risk factors of hospital death. Corticosteroids use was associated with a trend toward higher hospital mortality (OR 3.668, 95% CI 0.987 to 13.640, p = 0.052).

Conclusions. Hospitalized patients with 2009 H1N1 influenza had relative poor outcome. The risk factors at hospitalization may help clinicians to identify the high-risk patients. In addition, corticosteroids use should not be regarded as routine pharmacologic therapy.


Changes in knowledge, perceptions, preventive behaviors and psychological responses in the pre-community outbreak phase of the H1N1 epidemic
Lau JTF, Griffiths S, Au DWH, et al. Epidemiol Infect. 27 August 2010. doi:10.1017/S0950268810001925.
Available at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7881493

Summary. To investigate the changes in community responsiveness during the pre-community-outbreak phase of the H1N1 epidemic in Hong Kong, a pooled sample of 999 adults was interviewed in three surveys (S1, S2, S3) from 7 May to 6 June 2009. Over time, fewer people felt confident in staying free from H1N1 infection in the following year (S1, 63·3%; S3, 46%; P<0·001). The level of distress due to H1N1 remained modest throughout the study period. People's confidence in the government's ability to control a large-scale H1N1 outbreak declined slightly at the third survey (S1, 80·5%; S3, 73·8%; P=0·025). Across the three surveys, respondents remained vigilant with frequent adoption of preventive measures (e.g. wearing face masks in public areas when suffering from influenza-like symptoms and frequent hand-washing). The public was generally supportive of the Hong Kong government although misconceptions regarding the disease were common. Provision of evidence-based public-health education is still warranted as the disease outbreak unfolds.


Design of a robust infrastructure to monitor the safety of the pandemic A(H1N1) 2009 vaccination program in Taiwan
Huang W-T, Chen W-W, Yang H-W, et al. Vaccine. 30 August 2010.doi:10.1016/j.vaccine.2010.08.069.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-50WYGH2-2&_user=10&_coverDate=08%2F30%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=84b0e2c9179cbeeb8aca2f7677b828ed&searchtype=a

Abstract. On November 1, 2009, Taiwan began a nationwide pandemic A(H1N1) 2009 vaccine (“H1N1 vaccine”) program to control the influenza pandemic. Timely assessment of immunization safety during this mass vaccination campaign was a public health priority. Therefore, the government developed a national postlicensure safety surveillance strategy to identify and evaluate new, unexpected, or prioritized adverse events in recipients of H1N1 vaccine in near real-time. We describe the design and methodology of this new safety assessment infrastructure, address challenges encountered, and its potential future use for routine vaccine pharmacovigilance in Taiwan.


Perceptions of Immunization Information Systems for Collecting Pandemic H1N1 Immunization Data within Canada's Public Health Community: A Qualitative Study
Heidebrect CL, Foisy J, Pereira JA, et al. BMC Public Health. 31 August 2010.10:523.doi:10.1186/1471-2458-10-523.
Available at http://www.biomedcentral.com/1471-2458/10/523

Background. Immunization information systems (IISs) are electronic registries used to monitor individual vaccination status and assess vaccine coverage. IISs are currently not widely used across Canada, where health jurisdictions employ a range of approaches to capture influenza immunization information. Conducted in advance of the 2009 H1N1 vaccination campaign, the objectives of this study were to understand the perceived value of individual-level data and IISs for influenza control, identify ideal system functions, and explore barriers to implementation.

Methods. In July and August 2009, semi-structured interviews were conducted with key informants engaged in vaccine delivery and/or pandemic planning at regional, provincial/territorial and federal levels across Canada. Key informants were recruited using a combination of convenience and snowball sampling methodologies. Qualitative analysis was used to extract themes from interview content.

Results. Patient management, assessment of vaccine coverage, and evaluation of safety and effectiveness were identified as public health priorities that would be achieved in a more timely manner, and with greater accuracy, through the use of an IIS. Features described as ideal included system flexibility, rapid data entry, and universality. Financial and human resource constraints as well as coordination between immunization providers were expressed as barriers to implementation.

Conclusions. IISs were perceived as valuable by key informants for strengthening management capacity and improving evaluation of both seasonal and pandemic influenza vaccination campaigns. However, certain implementation restrictions may need to be overcome for these benefits to be achieved.


Predicting Need for Hospitalization of Patients with Pandemic (H1N1) 2009, Chicago, Illinois, USA
Vasoo S, Singh K, Trenholme GM. Emerg Infect Dis. October 2010 [Epub ahead of print] doi: 10.3201/eid1610.091889.
Available at http://www.cdc.gov/eid/content/16/10/PDFs/09-1889.pdf

Abstract. In the absence of established guidelines for hospitalization of patients with pandemic (H1N1) 2009, we studied emergency department patients to identify clinical parameters that predict need for hospitalization. Independent predictors of hospitalization include multiple high-risk medical conditions, dyspnea, and hypoxia. These findings are easily applicable, with a 79% positive predictive value for hospitalization.


Persistence of Avian Influenza Virus (H5N1) in Feathers Detached from Bodies of Infected Domestic Ducks
Yamamoto Y, Nakamura K, Yamada M, et al. Appl Environ Micobiol. August 2010. 76(16):5496-5499. doi:10.1128/AEM.00563-10.
Available at http://aem.asm.org/cgi/content/abstract/76/16/5496

Abstract. Asian lineage highly pathogenic avian influenza virus (H5N1) continues to cause mortality in poultry and wild bird populations at a panzootic scale. However, little is known about its persistence in contaminated tissues derived from infected birds. We investigated avian influenza virus (H5N1) persistence in feathers detached from bodies of infected ducks to evaluate their potential risk for environmental contamination. Four-week-old domestic ducks were inoculated with different clades of avian influenza virus (H5N1). Feathers, drinking water, and feces were collected on day 3 postinoculation and stored at 4°C or 20°C. Viral persistence in samples was investigated for 360 days by virus isolation and reverse transcription-PCR. Infectious viruses persisted for the longest period in feathers, compared with drinking water and feces, at both 4°C and 20°C. Viral infectivity persisted in the feathers for 160 days at 4°C and for 15 days at 20°C. Viral titers of 104.3 50% egg infectious doses/ml or greater were detected for 120 days in feathers stored at 4°C. Viral RNA in feathers was more stable than the infectivity. These results indicate that feathers detached from domestic ducks infected with highly pathogenic avian influenza virus (H5N1) can be a source of environmental contamination and may function as fomites with high viral loads in the environment.


Do as I say, not as I do: Handwashing compliance of infectious diseases experts during influenza pandemic
Kantele A, Kanerva M, Seppanen M, et al. Am J Infect Control. September 2010. 38(7):579-580.doi:10.1016/j.ajic.2010.03.001.
Available at http://www.ajicjournal.org/article/PIIS0196655310001458/fulltext

Background. We are living in the middle of an influenza pandemic, and infectious diseases experts all over the world have made an enormous effort to provide guidelines for how to control the situation. The most important single recommendation is to wash hands with water and soap. Epidemiologic evidence indicates that handwashing with soap (HWWS) prevents approximately 30% to 47% of children's diarrheas1 and 23% of respiratory infections.2 As the risk of catching respiratory tract infections is increased in public places, one would expect HWWS to be favored at toilets, the only places where washbasins and soap are available. We carried out an observational study on HWWS compliance among infectious diseases experts after toilet use during the current pandemic.


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.


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


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


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