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Vol. XIII No. 24 ~ EINet News Briefs ~ Nov 26, 2010


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

1. Influenza News
- Global: 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO situation update on pandemic influenza H1N1
- Global: WHO notes few influenza hot spots
- Hong Kong: New case of H5N1 avian influenza

2. Infectious Disease News
- Hong Kong: Upper respiratory tract infections being monitored
- Hong Kong: Warning issued after increased number of chickenpox cases
- Russia (Tartarsan): Increase in cases of hemorrhagic fever with renal syndrome
- Canada (Ontario): C. dificile outbreak being controlled
- Canada (Port Colborne): C. dificile outbreak declared over
- Canada (Ontario): New MRSA case and VRE outbreak
- Chile: Hantavirus cases
- USA (California): Listera finding prompts widening of cheese recall
- USA (Illinois): Norovirus at three facilities
- USA (Kentucky): Whooping cough outbreak
- USA (Missouri): Parents blame school for impetigo
- USA (Ohio): Whooping cough outbreak
- USA (Texas): Seven new whooping cough cases
- USA (Wisconsin): Norovirus warning

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

4. Articles
- Effectiveness of inactivated influenza vaccine in children aged 9 months to 3 years: an observational cohort study
- Modeling the cost of influenza: the impact of missing costs of unreported complications and sick leave
- Influenza Vaccine — Safe, Effective, and Mistrusted
- Comparison of Pandemic and Seasonal Influenza Reveals Higher Mortality and Increased Prevalence of Shock in Children With Severe H1N1/09 Infection
- The Impact of the H1N1 Pandemic on Canadian Hospitals
- Rapid detection of pandemic influenza in the presence of seasonal influenza
- Avian influenza research by FAO and partners focused on China’s Qinghai Lake

5. Notifications
- APEC Hot Topics Videoconference
- Cell Symposia – Influenza: Translating Basic Insights
- International TB Symposium (ITBS-2010): TB Diagnostics – Innovating to Make an Impact
- Keystone Symposia: Tuberculosis: Immunology, Cell Biology and Novel Vaccination Strategies


1. Influenza News

Global
Global: 2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Cambodia / 1 (1)
China / 2 (1)
Egypt / 22 (9)
Indonesia / 8 (7)
Viet Nam 7 (2)
Total / 40 (20)

***For data on human cases of avian influenza prior to 2010, go to:
http://depts.washington.edu/einet/humanh5n1.html

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 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):
http://www.wpro.who.int/sites/csr/data/data_Graphs.htm

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

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

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Global: WHO situation update on pandemic influenza H1N1
Worldwide, influenza activity remains low, except in limited areas of tropical Asia and temperate South America. Although the winter influenza season in the temperate zone of the Southern Hemisphere formally concluded during early October 2010 and generally transmission has been negligible since then, there have been recent reports of localized, late season epidemic influenza activity in Argentina, most notably in several provinces in the northwestern part of the country. As the temperate zone of the Northern Hemisphere enters the late autumn and winter months, influenza activity remains at or below seasonal baseline in most countries of Europe, North America, and temperate Asia. Seasonal influenza B and A(H3N2) viruses continue to co-circulate worldwide, with the later slightly predominant; influenza H1N1 (2009) virus circulation continues to be detected at low to moderate levels across Asia, and sporadically in other parts of the world.

In most countries of the temperate zone of the Southern Hemisphere, influenza virus circulation remained low to sporadic and ILI activity levels remained near or below baseline. In Argentina, however, there have been recent reports of localized, late season epidemics of influenza occurring during September and October 2010 in the several northwestern and far southern provinces. These outbreaks have been associated with circulation of influenza A viruses (some isolates have been characterized as seasonal influenza A(H3N2) but most have not been subtyped). In neighboring Chile, overall influenza activity remained low through late October 2010 after a recently concluded influenza season characterized by a predominance of circulating seasonal influenza A(H3N2) viruses. In South Africa, small numbers of influenza B viruses continued to be detected as the winter influenza season came to an end. In Australia, low level co-circulation of influenza B and H1N1 (2009) viruses continued to be detected through early November 2010 as levels of ILI remained low.

Several countries of Southeast Asia continued to report active circulation of influenza viruses. In Thailand, as of mid to late October 2010, there continued to be reports of active but declining co-circulation of seasonal influenza A(H3N2), B, and influenza H1N1 (2009) viruses. In neighboring Cambodia, since September 2010, there has been sustained active circulation of predominantly seasonal A(H3N2) viruses, but also to a lesser extent, seasonal influenza B and H1N1 (2009). In Hong Kong SAR (China), small numbers of seasonal influenza A(H3N2) viruses continue to be detected as levels of ILI have largely returned to seasonal levels after a recently concluded period of epidemic influenza activity. In Singapore, sustained co-circulation of seasonal influenza and H1N1 (2009) viruses has been observed, in varying proportions over time, since April 2010; levels of ARI have remained within the expected seasonal range over past two months. Elsewhere in Asia, Sri Lanka has reported a recent increase in the circulation of seasonal influenza A(H3N2), B, and H1N1 (2009) viruses, while in both Bangladesh and India, influenza activity appears to have significantly subsided after a period of persistent influenza virus circulation since March and June 2010, respectively.

In most countries in the tropics of the Americas, influenza activity has largely subsided. This comes after a period of variable influenza virus transmission spanning late July through early October 2010 during which many countries in the region observed active circulation of seasonal A(H3N2) viruses, while a few noted either seasonal influenza B or H1N1 (2009) activity. More recently, during October 2010, low to moderate levels of influenza A(H3N2) and H1N1 (2009) viruses have been detected in parts of Bolivia and Colombia, respectively.

Limited data from the tropical areas of sub-Saharan Africa suggest that overall influenza activity has remained low. Since late spring and late summer, there has been persistent low levels of circulation of seasonal influenza A(H3N2) viruses in Kenya and Madagascar, respectively. During late September through mid-October 2010, Cameroon, in central Africa, has also begun to detect significant levels of seasonal influenza A(H3N2) and B viruses. In contrast, little influenza activity has been reported in West Africa during recent months, except in Togo, which has recently reported small numbers of H1N1 (2009) virus detections.

In Canada and the United States, overall influenza activity and levels of ILI remained near or below baseline; small numbers of seasonal influenza A(H3N2) and B viruses have been detected during the past month.

Most countries in the European Region continued to report low overall levels of ILI activity, with sporadic detections of influenza A(H3N2), H1N1 (2009) and influenza B viruses.

As of late October 2010, overall influenza activity remained low to sporadic in China and Japan. In both, seasonal influenza A(H3N2) viruses were detected at low levels during October 2010.

On 12 November, 2010, the United States Centers for Disease Control and Prevention (US CDC), reported two sporadic cases of human infection with triple reassortant swine origin influenza A(H3N2) viruses. The two cases occurred in separate states, are not believed to be epidemiologically linked to each other, and both occurred in the vicinity of live pigs. Both patients have fully recovered from their illness. The viruses isolated from both patients had some genetic differences further suggesting that two cases were not linked. Investigations thus far have not shown any evidence of community transmission of these viruses.

The first detection in a human of the triple reassortant swine A(H3N2) virus was in 2005 in Ontario Canada. Since then human cases have been reported nearly every year. All cases have fully recovered and no increased severity has been associated with the infection with these viruses in humans.

In North America, A(H3N2) viruses in pigs emerged around 1998-99, when the human influenza A(H3N2) viruses entered into swine population and reassorted with other influenza viruses already circulating in pigs. The A(H3N2) viruses currently circulating in the swine population in US and Canada contain gene segments from avian-like, swine-like, and human-like viruses.

Early identification and investigation of human infections with novel influenza A viruses is critical to evaluate the extent of the outbreak and possible human-to-human transmission and WHO continues to encourage member states to investigate and report these events.

On 17 November 2010, the Department of Health of Hong Kong SAR, China, reported a confirmed human case of influenza A(H5N1) virus infection to WHO. The case has a travel history to Shanghai, Nanjing and Hangzhou. The investigation is still ongoing but based on current information this is a sporadic case of human infection with influenza A(H5N1) virus without secondary spread.

On November 5, two cases of human infection with swine-origin triple reassortant A(H3N2) viruses were reported by CDC through IHR.

During weeks 43 to 44 (24 October to 6 November 2010), National Influenza Centers (NICs) from 43 countries reported data to FluNet*. A total of 1,442 specimens were reported as positive for influenza viruses, 1,123 (77.9%) were typed as influenza A and 313 (21.7%) as influenza B. Of the sub-typed influenza A viruses reported, 23.8% were influenza H1N1(2009) and 75.5% were influenza A(H3N2).

Influenza virus detection by type/subtype in countries:

* Influenza H1N1 (2009): Australia, Bolivia, Brazil, Cambodia, Cameroon, China, China Hong Kong SAR, Fiji, Ghana, Guadeloupe, Ireland, Japan, Kenya, Lao People's Democratic Republic, Norway, Singapore, South Africa, Sri Lanka, Togo and United States of America. * Influenza A(H3N2): Algeria, Australia, Bolivia, Brazil, Cambodia, Cameroon, Canada, Chile, China, China Hong Kong SAR, Costa Rica, Cuba, Fiji, French Guiana Ghana, Ireland, Japan, Kenya, Madagascar, Mexico, Mongolia, Norway, Republic of Korea, Singapore, South Africa, United Kingdom and United States of America.
* Influenza A(H1N1): China
* Influenza B: Algeria, Australia, Bolivia, Brazil, Cambodia, Cameroon, Canada, Chile, China, China Hong Kong SAR, Costa Rica, Cuba, El Salvador, Honduras, Ireland, Kenya, Lao People's Democratic Republic, Norway, Singapore, South Africa, Sri Lanka, Togo, United Kingdom and United States of America.

Afghanistan, Denmark, Estonia, Ethiopia, Finland, France, Greece, Iran (Islamic Republic of), Martinique, Morocco, Poland, Republic of Korea, Romania, Russian Federation, Slovenia, Spain, Switzerland and Tunisia reported no influenza activity.
(WHO 11/19/2010)

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Global: WHO notes few influenza hot spots
The WHO said flu activity is still low in most parts of the world, but a few areas, such as Argentina, are showing increasing activity. Rising late-season flu levels in Argentina are mainly occurring in the country's northwestern provinces. Colombia and Bolivia have recently reported low-to-moderate H3N2 and 2009 H1N1 virus activity. In the tropics, Southeast Asian countries are still reporting flu virus circulation, and Sri Lanka recently reported increasing activity. In Africa, Cameroon is reporting significant levels of H3N2 and influenza B viruses, and Togo recently reported a few 2009 H1N1 detections. The WHO report acknowledged the two recent triple-reassortant swine-origin H3N2 virus infections in the United States and the isolated H5N1 avian influenza case in Hong Kong. On a global level, an analysis of flu viruses tested through 6 November 2010 found that about 77% were influenza A and about 22% were influenza B. Of the influenza A viruses subtyped, 75% were seasonal H3N2. China was the only country reporting the seasonal H1N1 virus.
(CIDRAP 11/24/2010)

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Asia
Hong Kong: New case of H5N1 avian influenza
The Centre for Health Protection (CHP) of the Department of Health (DH), Hong Kong, China has reported a new confirmed human case of H5N1 infection on 17 November 2010. The case is a 59 year old woman. She developed symptoms on 2 November 2010 and was admitted to hospital on 14 November 2010. She was diagnosed with pneumonia and is now in a critical condition.

The case had a history of travel to Shanghai, Nanjing, and Hangzhou. She reported no history of contact with live birds and poultry in the days before developing symptoms. Her close contacts are under surveillance and are isolated. All remain asymptomatic to date. Nasopharyngeal aspirates of all close contacts were negative for H5. Investigations into the source of her infection are ongoing.

Evidence so far indicates a sporadic case of human influenza A(H5N1) infection without secondary spread. So far, a total of 21 human cases of influenza A (H5N1) infection were recorded in Hong Kong SAR China, including 18 cases in 1997, two cases in 2003 and the current case in 2010.

[ProMED note: This is the WHO confirmation of the human case of avian influenza A/(H5N1) virus infection in the Hong Kong SAR. Essentially, there has been no additional information since the release of this report and the CHP statement. As of 22 November 2010, there has been no confirmation of onward transmission of infection, and the circumstances of the patient's exposure to infection remain obscure. The patient remains alive.]
(ProMED 11/22/2010)

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2. Infectious Disease News
Hong Kong: Upper respiratory tract infections being monitored
The Centre for Health Protection (CHP) of the Department of Health is investigating a suspected outbreak of upper respiratory tract infection (URI) affecting 16 students aged five to 10 and four staff members of a primary school in Kowloon City.

Those affected, comprising 14 males and six females, developed symptoms of URI including fever, cough, runny nose and sore throat since 6 November 2010.

All of them remain stable and none have required hospitalization.

CHP staff have visited the school and provided health advice to the management. The school has been put under medical surveillance.

Members of the public, particularly children, elderly people and those with chronic diseases, should wear face masks and consult their doctors for medical advice promptly if they develop symptoms of URI.
(7th Space Interactive 11/23/2010)

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Hong Kong: Warning issued after increased number of chickenpox cases
Health authorities have called for vigilance following a recent surge in the number of chickenpox cases. The figure for November 2010 exceeds 1,000, which is almost double the figure for the same period in 2009. A pediatrician and vice-chairman of the Medical Association, Dr Alvin Chan, said the situation was unusual. He said that parents should take stringent hygiene measures to prevent the disease.
(HealthMap 11/23/2010)

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Russia (Tartarsan): Increase in cases of hemorrhagic fever with renal syndrome
Between 12 and 18 November 2010, 12 new cases of haemorrhagic fever with renal syndrome (HFRS) were registered in the Republic of Tatarstan. The majority of the of cases (three) are from Kazan [the capital of Tatarstan], two cases were recorded in Almetevsk region, and single cases in another seven regions.

[ProMED note: According to the preceding ProMED-mail report from Tatarstan (Hemorrhagic fever w/renal synd. - Russia (08): (TT) 20101029.3928) the cumulative number of HFRS cases in Tatarstan up to the end of October 2010 was 17. The total of 12 cases over only a single week reported above signifies the start of the epidemic season for HFRS in Tatarstan, which is explained by the increased reproductive activity of voles, the main carrier of HFRS.

Although not specifically stated, it is likely that Puumala virus is the specific hantavirus responsible for this outbreak of HFRS in Tatarstan, and the rodent reservoir is the bank vole (Myodes glareolus).]
(ProMED 11/25/2010)

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Americas
Canada (Ontario): C. dificile outbreak being controlled
A provincial inspection team is optimistic a C. difficile outbreak at St. Joseph's Healthcare can be brought under control soon, despite another related death and three new cases.

The outbreak has resulted in 43 cases and six related deaths since the beginning of October 2010.

The team's visit to St. Joe's hospital 19 November 2010 produced one key recommendation, according to infectious disease control expert and team leader Dr. Michael Gardam. The hospital could adopt a more aggressive cleaning protocol that calls for cleaning more often and in more hospital areas with an agent that kills C. diff bacteria spores.

C. difficile is an infection that causes severe diarrhea, nausea and painful cramping, among other symptoms, and can result in serious complications and even death.

St. Joe's president Dr. David Higgins said the visit and advice were extremely helpful.

Gardam said St. Joe's was already ahead of the other 20 to 25 hospitals with outbreaks that have been visited by the infection control resource team. The team is one of two with the Ontario Agency for Health Protection and Promotion.

Although the visit was not a scientific audit, there is a general sense St. Joe's is on a positive path, Gardam said. He said that they had a lot less to recommend there than in other hospitals.

Other recommendations are long term and aimed at avoiding such outbreaks in the future. These include adopting antibiotic stewardship, in which a dedicated hospital pharmacist oversees and monitors the length of use for all dispensed antibiotics, and ways to change hospital culture so that handwashing is as automatic as putting on a seatbelt is when entering a car.

Higgins said St. Joe's first goal is to bring the outbreak under control. The long-term goal is to optimize care for C. diff patients.
(TheSpec.com 11/20/2010)

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Canada (Port Colborne): C. dificile outbreak declared over
The NHS says a C. difficile outbreak in Port Colborne is over.

Under provincial legislation, a healthcare facility must declare an outbreak when there are a higher than normal number of new hospital-acquired cases over a 30-day period.

When the outbreak was declared on 20 October 2010, there were three confirmed cases.

An outbreak may be declared over when there are no new cases and the number of cases has returned to the baseline level.
(CKTB 11/19/2010)

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Canada (Ontario): New MRSA case and VRE outbreak
No new cases of the Clostridium difficile infection were identified at Peterborough Regional Health Centre (PRHC) the week of 15 November 2010.

However, one new case of methicillin-resistant staphylococcus (MRSA) and a new outbreak of vancomycin-resistant enterococcus (VRE) were identified after patients in a restricted section of the hospital were tested.

Unit B3, on the third floor of the hospital, is under specific restrictions; no new patients are being admitted and patients aren't being transferred from B3 to other parts of the hospital. Visitors are limited to two immediate family members at a time. As well, specially trained housekeeping staff members are carrying out heightened cleaning in rooms in B3.

It could be weeks before the restrictions are lifted, said Margaret Jay, PRHC's manager of infection prevention and control. Each week we'll be reassessing that, she said. She also said that they do prevalent screens on a weekly basis, so that means swabbing all the patients for the MRSA and the VRE to look for new cases. So they need to have no new cases in two subsequent prevalent screens.

The next test was performed on 22 November 2010, with results available 25 November 2010.

In the meantime, aside from the restrictions -- which also include supervised hand-washing during visiting hours -- it's business as usual on B3, Jay said. We have people well enough to be discharged, who are carrying the virus but still go home, she said.

The hospital identified a C. difficile outbreak 22 October 2010, with seven cases linked to it. No new cases have been reported in 16 days.

The MRSA outbreak was spotted 5 November 2010, with 12 cases identified.

The hospital identified the VSE outbreak 18 November 2010, with six cases (some results are still pending).

The cases of MRSA and VRE are something hospitals face, Jay said. The MRSA and VRE are viruses that have learned to become resistant to antibiotics, she explained. She added that in a hospital, they use a lot of antibiotics. So we tend to see this in hospitals, she said; it's quite common to see antibiotic-resistant organisms. Clostridium difficile, as well. In a hospital setting, this is not unusual.

MRSA and VRE can be present without symptoms, she said. The majority of the people with the MRSA and the VRE do not have an infection; there's only one case that actually has an infection, she said. They're carriers. So they wouldn't even realize they have it. It isn't bothering them at all.

The hospital continues to push hand-washing to staff, patients and visitors, Jay said. We actually promote it on a consistent basis. Every month we're doing audits and monitoring practice to ensure compliance. And we share that with the staff, to make sure there's additional information, she said.

PRHC has extensive signage for visitors and has positioned hand-washing stations loaded with cleansing gel throughout the facility.

It's important to tell them the importance of good hand hygiene, Jay said.

Preventing infection through hand-washing is one battle plan, she added, but said the key to the battle is balancing the need for antibiotics with the dangers of organisms on the attack.

The biggest issue is overuse of antibiotics anywhere. So it's about ensuring that we're using antibiotics appropriately, whether we're in the hospital or at home, as well. That's really important, that we only take antibiotics when we need them. That's a huge push, to ensure that we use them appropriately.
(Petersborough Examiner 11/19/2010)

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Chile: Hantavirus cases
The case of the young person who died in the Collipulli Hospital while being moved urgently to the Temuco Regional Hospital, corresponds to a new case of suspected hantavirus infection. This was confirmed by Loreto Uribe, in charge of the Melleco Provincial SERMI [Regional Ministerial Secretariat] Health Office. She said that she could not confirm the cause of the fatality while the corresponding laboratory analyses were not yet done. The woman who died is just suspected of having a hantavirus infection; some samples were taken after her death and sent to the Public Health Institute (ISP) in Santiago for confirmation, she said. The 23 year old woman lived with her two little children in the San Andres rural area, near Colipulli.

Meanwhile, in recent hours another case with similar characteristics was reported in the Niblinto rural area, also in Collipulli. This relates to a 51 year old man. This patient went to the Temuco Hospital, is in stable condition and also suspected of having a hantavirus infection, and under the same conditions, samples were sent to the ISP for subsequent testing, said the SEREMI Health representative.

It is worth recalling that to date, there exists just one confirmed fatal case registered in the Tranaman area, in the Puren community, where a 46 year old worker died. Also, some two to three suspected cases in the province were registered, which were discarded as hantavirus infections.

One of the main recommendations to prevent the disease [and discourage the presence of the long-tailed pygmy rice rat that is the reservoir of Andes hantavirus - Mod.TY] in rural areas is to store firewood 30 cm [12 in] or more above ground level and at a distance of 30 m [1170 ft] from the house and maintain the areas around houses, urban spaces and cultivated areas free of weeds and low-level vegetation.

Also, it is advised that before entering closed places, sheds or unoccupied cabins, these places should be ventilated for several hours and the use of masks is recommended since it has been detected that the inhalation of rodent excreta in closed places is one of the main risk factors.

[ProMED note: Although not stated, the hantavirus responsible for HPS (hantavirus pulmonary syndrome) in the area mentioned above is Andes virus. Chile has had a series of HPS cases especially in January – May of 2010, and the season for transmission is again coming, with reports of new suspected cases and warnings about the risk of infections and how to prevent them.]
(ProMED 11/24/2010)

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USA (California): Listera finding prompts widening of cheese recall
Bravo Farms, the California company that recalled its Gouda cheese because of Escherichia coli O157:H7 contamination, on 22 November 2010 announced it has expanded its recall to include all of its cheese after an investigation at the plant turned up Listeria monocytogenes as well as E coli. No Listeria illnesses have been linked to Bravo Farms cheeses, which are sold at retail locations primarily on the West Coast. Varieties subject to the expanded recall include pepper jack, Tulare Cannonball, and several types of cheddar. The pathogens at the plant were detected by the California Department of Food and Agriculture. The company recalled its Gouda on 8 November 2010 after investigations in a handful of western states linked E coli infections to the Bravo Farms cheese, which was sampled and sold at some Costco stores. So far 37 illnesses have been connected to the outbreak, and the outbreak strain has been found in opened and unopened packages of Bravo Farms Gouda.
(CIDRAP 11/23/2010)

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USA (Illinois): Norovirus at three facilities
An outbreak of norovirus has been reported after 129 people became ill in three long-term care facilities, according to the McHenry County Department of Health.

Fourteen cases of norovirus, which is highly contagious, have been confirmed and five people have been hospitalized. MCDH spokeswoman Debra Quackenbush declined to release the names of the facilities where the virus was found, but said that their administrators are cooperating and taking steps to prevent it from spreading.

Unlike influenza, which is an upper respiratory virus, noroviruses are generally the culprit that causes what is referred to as "stomach flu." It affects the intestinal tract and causes nausea, vomiting and diarrhea. Symptoms usually last between 24 and 48 hours.

Norovirus is common but can be fatal in rare cases, particularly when the person has a compromised immune system, Quackenbush said. The illness, which easily transfers from person to person, cannot be treated with antibiotics.
(Northwest Herald 11/23/2010)

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USA (Kentucky): Whooping cough outbreak
Nearly two dozen lab-confirmed cases of whooping cough have been reported during November 2010 among children seven and younger in Montgomery County, county health department officials announced.

Health department officials recommend that adults get immunized against whooping cough to avoid spreading the disease to children. The disease is most harmful to infants and can cause death, although fatalities are rare.

Jennifer Gulley, deputy public health director for Montgomery County, said there has been an increase in cases since 2001.

Children receive DTaP vaccinations, which protect then against tetanus, whooping cough and diphtheria, at two, four and six months, 15 to 18 months and four to six years. Middle school students also are given vaccines. Adults should receive the Tdap booster, which protects them against the same three diseases, because immunity wanes over time.

Adults and adolescents who have not been vaccinated can spread the disease without realizing it.

That's how we're going to control this outbreak, Gulley said. By getting community immunity.

Although there are whooping cough cases each year, the 21 confirmed cases in Montgomery County is an unusually high number and the most the county has seen in recent years, she said.

There are three million cases of whooping cough reported in the United States each year. Montgomery County Health Department officials said other Kentucky counties also have had reported cases this year.

The Montgomery County Early Learning Center and Camargo and Mount Sterling elementary schools each had one confirmed case of whooping cough. Parents are being instructed to call their primary care providers if necessary for treatment.

Donna McGuire, a spokeswoman for the school district, said the superintendent recently asked bus drivers to use sanitizing spray more often to clean school buses in light of the outbreak.

McGuire said this would be another layer of protection alongside other measures to prevent the spread of germs, especially after the spread of H1N1 last year. Hand sanitizer is available throughout buildings.

It's not new to us to have to try to be preventative, McGuire said. That's been a habit anyway.

Only people who were within three feet of a sick person for at least an hour are considered contacts who might need antibiotic treatment, health officials said.

People diagnosed with whooping cough should stay home from work or school during the first five days while taking antibiotics prescribed by a physician. After the five days, coughing might continue for up to 10 weeks but the disease is no longer contagious, health department officials said.

Whooping cough symptoms might include vomiting and severe coughing if left untreated. The severe coughing can cause cracked ribs and hernias.
(Lexington Herald-Leader 11/24/2010)

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USA (Missouri): Parents blame school for impetigo
Six wrestling team members from Troy Buchanan High School, located in Troy, Missouri, are recovering from a contagious skin infection.

One parent is blaming the school district for the outbreak known as impetigo.

Jennifer Duggins says her son, Andrew, picked up the infection from dirty mats at wrestling practice.

Duggins also says that the school needs to take precautions that the children are not ending up in the hospital.

April Bryant, the school district spokesperson, disagrees with Jennifer Duggins’ theory and says the school is not responsible for the outbreak.

Bryant added that the mats are cleaned before and after practice and that all 144 wrestlers used the same mats and only six were infected.

The district did a pandemic cleaning of Troy Buchanan High School after they learned of the infections.
(KMOV 11/19/2010)

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USA (Ohio): Whooping cough outbreak
The whooping cough outbreak continues to get worse, with 40 new cases reported in Columbus and Franklin County in one week, health officials said 22 November 2010.

As of 13 November 2010, there were 781 reported cases, the most in 25 years. Because many people don't seek medical attention for their symptoms, the number of cases could be closer to 3,000, officials say.

Columbus Public Health officials now are posting weekly whooping cough reports online for health providers and others.

Whooping cough, or pertussis, is a bacterial disease characterized by a persistent cough that can end with a whoop sound.

It often is confused with a cold because it causes similar symptoms at the onset.

Because whooping cough can be fatal in infants, officials continue to urge everyone, especially those who come in contact with young children, to get vaccinated.

Everybody that has contact with a young one that may be at risk should get fully vaccinated," said Jose Rodriguez, spokesman for Columbus Public Health.
(The Columbus Dispatch 11/23/2010)

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USA (Texas): Seven new whooping cough cases
A northwest Harris County preschool has been hit by whooping cough, the Houston area’s first cluster of cases in what has been a bad season nationally.

Officials at The Adventure Preschool & Windwood Christian Academy on Spring Cypress Road last week sent letters to parents of preschoolers after seven children were confirmed to have the highly contagious bacterial infection, said a Harris County health department spokeswoman.

The children are being treated.

Whooping cough is out there, said Rita Obey, spokeswoman for the Harris County Public Health and Environmental Services. We haven't had any clusters, but there has been a case here and a case there.

In Houston, four cases were reported in September and two in October 2010.

Whooping cough, also known as pertussis, is particularly hard on youngsters' developing lungs and causes 40 to 80 infant deaths a year in the United States.

Characterized in infants by episodes of rapid coughing following by a high-pitched "whoop" sound, it is the nation's only common vaccine-preventable disease on the rise.

Whooping cough has spread rapidly in a number of states in 2010, particularly California, where 1,500 children have been diagnosed and 10 died in what officials are calling the worst outbreak in 50 years.

Central Texas is also having one of its worst outbreaks in years.

Because The Adventure Preschool is out for Thanksgiving, health officials said they believe they can keep the outbreak from spreading. All the preschoolers and any adults who had contact with them were put on a five-day course of preventive antibiotics.
(Houston Chronicle 11/23/2010)

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USA (Wisconsin): Norovirus warning
A gastrointestinal illness known to spread in the late fall and winter is showing up in Dane County. And with Thanksgiving right around the corner, health officials have a reminder: wash your hands to avoid spreading what's called norovirus. Amanda Kita Yarbro is an epidemiologist with Public Health Madison-Dane County.

We didn't want people to have these symptoms and think, 'Oh, I really need to make that pie for Grandma's house’ and then make their whole family sick because they made food while they were ill, says Yarbro.

The week of 15 November 2010, schools in Illinois were hit with norovirus. Symptoms include vomiting, diarrhea, stomach cramps and low fever.
(Superior Telegram 11/23/2010)

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

- WHO regional offices
Africa: http://www.afro.who.int/
Americas:
http://new.paho.org/hq/index.php?option=com_content&task=blogcategory&id=805&Itemid=569
Eastern Mediterranean: http://www.emro.who.int/csr/h1n1/
Europe: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/influenza/pandemic-influenza
South-East: http://www.searo.who.int/EN/Section10/Section2562.htm
Western Pacific: http://www.wpro.who.int/health_topics/h1n1/

- North America
US CDC: http://www.cdc.gov/flu/swine/investigation.htm
US pandemic emergency plan: http://www.flu.gov
MOH México: http://portal.salud.gob.mx/index_eng.html
PHA of Canada:
>http://fightflu.ca

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

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VECTOR-BORNE DISEASE
Indonesia (Bali)
Dengue fever has killed 29 residents of the Indonesian resort island of Bali since January 2010. They were among 10,230 residents who suffered from the dengue fever virus between January-October 2010. Bali's population is 3.9 million.
(ProMED 11/15/2010)


Indonesia
West Nusatenggara had a total of 1,781 dengue fever cases in the January-October 2010 period, up from 625 in the same period in 2009, a local public health official said.

The number of dengue fever sufferers in 2010 was much higher than in 2009, the head of disease control and environment, health office of West Nusa Tenggara, I Made Suadnya, said.

He said dengue fever was an acute disease caused by the dengue virus and transmitted by mosquitoes. The disease is found in tropical and sub-tropical regions including in many Southeast Asian countries.

There were four types of dengue virus, each of which can cause dengue fever, either mild or fatal.

Dengue fever is transmitted to humans through the bite of female Aedes mosquito infected by dengue virus. The disease can not be transmitted directly from person to person. The main spreaders of dengue virus is Aedes aegypti mosquito and can also spread by other species of Aedes albopictus.

According to Suadnya the high number of dengue fever cases in West Nusa Tenggara are due to climate change which is characterized by continuous rainfall every month in 2010. The condition supports the breeding of Aedes aegypti mosquito larvae.

In addition, factors such as water tanks continuing to be left open support the mosquito breeding, he said.

Suadnya mentioned, the most dengue fever patients was Mataram with the number of cases reached to 940 followed by some district Namley Sumbawa 159 cases, East Lombok 139 cases, West Lombok 112 cases, West Sumbawa 87 cases, Dompu 120 cases, Central Lombok 65 cases, North Lombok district 56 cases and Bima 44 cases.

Of all the cases, eight sufferers died and the most were in Dompu district (four people) followed by Sumbawa (three people) and one in Mataram city, he added.

In 2009 West Sumbawa district had no cases, but this year reached to 87 cases. In 2009, Dompu only had one case but now has over 100 cases," Suadnya noted.

Based on these conditions his side continues to urge people to control mosquito breeding with effective and efficient eradication of mosquito breeding sites.

Besides that, the health office also increases the role of medical personnel in villages to give counseling for people about the importance of keeping the environment clean in order to avoid many dangerous diseases.
(Antara News 11/23/2010)


Philippines
As of 18 November 2010: the death toll from dengue fever in the Philippines has reached 724 since the start of 2010, the Department of Health said. The deaths recorded from 1 January-30 October 2010, were up nearly 50 per cent from 485 fatalities in the same period in 2009. The health department also recorded a total of 119,789 cases of dengue infections, an increase of more than 140 per cent from 49,319 in 2009.
(ProMED 11/22/2010)


Thailand (Phuket)
Phuket City Municipality has designated four city temples as “pilot areas” in the battle to stop the spread of dengue fever.

Phuket Town Mayor Somjai Suwansupapana told the state-run MCOT news agency there have been 693 confirmed cases of dengue in the city so far in 2010.

The number of new cases being reported is on the rise. Monsoon season rainfall, flooding and blocked drains create pools of stagnant water where mosquitoes that vector the disease can breed, she said.

To combat the spread of dengue, four temples have been designated as model areas with strict mosquito control measures in force at all times.

The four temples are Wat Saensuk, Wat Kajonrangsan, Wat Puttamongkol-nimit and Wat Wichitsangkaram.

The temples will also serve as centers where public health workers will inform monks and people in the surrounding community about the steps they can take to eradicate mosquito larvae in and around their homes.

The sessions will be held three times a month.

The temples will also serve as a staging area for pesticide fumigation in risk areas, which is also scheduled to take place three times per month.

Health workers will collect mosquito specimens in each area for analysis to determine if they are resistant to pesticides. The analysis will help them determine which pesticides to use in future fumigations.

Wat Saensuk, in the lower east side of Phuket Town near Robinsons department store, has been designated as the command center where all data about the project will be kept.

The Gazette reminds people taking part in Loy Kratong activities to protect themselves from mosquito bites by wearing long-sleeved clothing and mosquito repellent.
(ScandAsia.com 11/22/2010)


Viet Nam (Ho Chi Minh City)
Ho Chi Minh City recorded 2054 dengue fever cases during October 2010, an increase of 23 percent over September 2010. HCM City is the city with the highest number of dengue fever patients in the southern region, with 450 patients per week.
(ProMED 11/15/2010)

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CHOLERA, DIARRHEA, and DYSENTERY
Australia (Queensland)
Queensland Health says it is continuing to monitor the spread of cholera in Papua New Guinea (PNG) in the wake of unconfirmed reports the disease has spread closer to the Australian border.

At least 16 people have died from the disease after an outbreak on the PNG island of Daru.

Queensland Health says there have been no confirmed cases in Australia relating to the outbreak. Chief health officer Dr Jeannette Young says the risk of the outbreak spreading to the Torres Strait remains minimal.

We've got good ready access to safe drinking water up there and also human waste is disposed of appropriately, so I do want to reassure the islanders that the risk of an outbreak there is low, she said.

Queensland Health has set up an incident management team on Thursday Island to monitor the spread of the disease.

The department has also sent supplies to outer island health facilities and will hold a series of public meetings across the region.

Dr Young says simple measures can help protect residents.

They're the standard things - that they wash their hands with soap after going to the toilet and before handling any food, she said. She said they are also saying that at the moment they must cook any seafood items very thoroughly - so that includes clams and oysters and mussels.

Dr Young says PNG nationals who present to Queensland Health facilities in the Torres Strait will be treated.

Anyone who comes to the border, anywhere in Australia who's unwell, would be seen by health staff - whether it be Sydney airport, Brisbane airport or in the Torres Strait - they still receive treatment, she said.
(ABC News 11/22/2010)


Chile (Santiago)
The Chilean Health Ministry announced on 18 November 2010 that the country will launch a campaign to warn people of a possible spread of the cholera outbreak in Haiti.

Since we were informed about the outbreak in Haiti we knew it would be possible to be spread in different countries, said Andrea Olea, head of the Epidemiology Department of the Health Ministry.

In coming days there will be an information campaign mainly for travelers at the international airport and the border control points of the country, she said.

The campaign will not impose restrictions on people coming back to Chile from affected zones.

A major cholera outbreak occurred in October 2010 in Haiti and so far it has killed more than 1,000 people and infected 200,000 others. The epidemic has reportedly spread to some other countries, including the Dominican Republic and the United States.

Most of the people infected with cholera do not have symptoms and they get infected mainly due to bad hygiene and sanitary conditions, Olea said.

Cholera is spread through the water and food contamination and can easily spread if sanitary conditions are poor.
(Xinhua 11/18/2010)


Malaysia
Kedah Gerakan has urged the Pakatan Rakyat state government to take pre-emptive steps against any outbreak of waterborne diseases in the wake of the recent floods in the state.

Kedah Gerakan chairman Dr Cheah Soon Hai said the PAS-helmed government should issue immediate directives to health authorities to monitor the affected areas.

He said the state government should instruct health officials to work closely with the flood-affected residents to ensure only clean and hygienic water was supplied to them.

He said Gerakan was concerned with the welfare and health of the people.

We don't want an outbreak of diseases like diarrhoea and dysentery, the Derga state sssemblyman said in a statement.

Like neighbouring Perlis, Kedah was badly hit by floods due to the recent heavy downpour. Kubang Pasu, Kota Setar, Pokok Sena, Padang Terap and Pendang were among the districts badly affected forcing more than 30,000 to be evacuated to relief centers.

The situation had started to improve the week of 15 November 2010.

Meanwhile, Cheah also called on the state government to instruct the rural, city or municipal councils to deploy more workers to clear up the debris and clean up the affected areas.
v He claimed that feedback revealed that people were upset with the state government’s poor handling of the flood situation so far.

On another issue, he critiqued the state government for concealing its administrative weaknesses by blaming the federal government for the recent 27% water tariff hike in Kedah.

He chided Menteri Besar Azizan Abdul Razak’s administration for play-acting as powerless to decide on the water rate increase.

We are puzzled by the spin. Only a few days ago, the state government announced a one-month 30% discount for water usage in flood affected areas. Now it claims to have no power, he said. When the state government thinks a policy is bad, it blames the federal government. When a policy is good, it self-praises for making it happen, he added.

He said the state government's main agenda was to create confusion so that the people would misunderstand the Barisan Nasional federal government.
(Free Malaysia Today 11/19/2010)


Papua New Guinea
The outbreak of cholera in Daru, the capital of Papua New Guinea’s Western Province, appears to be stabilizing.

A team from the World Health Organization assessed the situation 15 November 2010 and as of 22 November 2010, the number of cases was 870 in Daru Hospital and a total of 30 confirmed deaths.

The WHO PNG representative Dr William Adu-Crow, says the severity of the outbreak has declined and fewer people are being admitted to hospital, with about 200 new cases over the past three days.

I think in Daru it is contained. The cases that we are getting indicates that for the Daru township. However we are not very confident that we can say it is contained in terms of what is coming from the mainland and that is what we keep monitoring.

Dr William Adu-Crow says five regions in the Western Province are still reporting new cases of cholera each day and deaths possibly related to the disease.
(Radio New Zealand International 11/23/2010)


USA (Massachuesetts)
Six students who live in Warren Towers have been treated at Boston Medical Center the week of 15 November 2010 for stomach pains, vomiting, and diarrhea. Another half dozen Warren residents are reportedly suffering from similar symptoms, as well as one student from West Campus.

Cheri LeBlanc, a staff physician at Student Health Services, has treated some of the students and says she is working with health officials from the city of Boston to learn if the illness is caused by a virus or bacteria. Health officials are collecting fluids for analysis, she says, and are looking for a common thread.

At this point we don’t know if this is caused by a common virus or by something else, like something the students ate, LeBlanc says.

While some students were quite sick, the physician says, most went to the emergency room because the illness struck when Student Health Services was not open. She says reports of the illness started appearing during the last four days.

LeBlanc advises all students to wash their hands carefully and frequently with soap and water, particularly after using the restroom and before preparing food. If soap and water are not available, she says, Purell hand sanitizers are also effective.

She recommends that those suffering from symptoms, such as diarrhea, should drink water or Gatorade to prevent dehydration, sipping it slowly and methodically instead of gulping it down.

All we can do at this point is offer what we call ‘supportive care,’” she says. “There really isn’t any medicine that will make this go away, so coming in to see us is going to be only so helpful.

Diane Adamson, who lives in a brownstone on Bay State Road, says she has heard about several sick students. People in C Tower have been getting sick, she says. It’s spreading up from the sixth floor. And there’s even a girl in my house who’s sick.

Samantha Baum has heard that the illness is a 24-hour bug. People usually complain about not feeling well, she says. They end up getting really sick for about a day.

Staff from Facilities Management and Planning are cleaning floors in Warren Towers, where the illness was first reported, and David Zamojski, assistant dean of students and director of Residence Life, is advising his team to tell students to wash their hands frequently and thoroughly.
(BU Today 11/18/2010)

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4. Articles
Effectiveness of inactivated influenza vaccine in children aged 9 months to 3 years: an observational cohort study
Heinonen S, Silvennoinen H, Lehtinen P, et al. Lancet Infect Dis. 23 November 2010. doi:10.1016/S1473-3099(10)70255-3.
Available at http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2810%2970255-3/abstract

Background. Few prospectively collected data are available to support the effectiveness of inactivated influenza vaccines in children younger than 2 years. We aimed to establish the effectiveness of trivalent inactivated influenza vaccine against laboratory-confirmed influenza A and B infections in a cohort of children younger than 3 years.

Methods. In a prospective cohort study during the influenza season of 2007—08 in Turku, Finland, between Jan 14 and April 9, 2008, we assessed the effectiveness of trivalent inactivated influenza vaccine against laboratory-confirmed influenza A and B infections in children aged 9 months to 3 years. Our study was part of a clinical trial on antiviral treatment of influenza in children (ClinicalTrials.gov, number NCT00593502). The vaccine was given as part of the Finnish vaccination programme as a 0·5 mL injection. Children enrolled into our study through mailed announcements and local advertisements were examined every time they had fever or signs of respiratory infection. No exclusion criteria were used for enrolment. Influenza was diagnosed with viral culture, antigen detection, and RT-PCR assays of nasal swab specimens. Vaccination status of children was determined by parental report. We calculated the primary effectiveness of influenza vaccination by comparing the proportions of infections in fully vaccinated and unvaccinated children in the follow-up cohort.

Findings. We enrolled 631 children into our study with a mean age of 2·13 years (range 9—40 months). Seven (5%) of 154 fully vaccinated children and 61 (13%) of 456 unvaccinated children contracted influenza during the study (effectiveness 66%, 95% CI 29—84; p=0·003). In the subgroup of children younger than 2 years, four (4%) of 96 fully vaccinated children and 21 (12%) of 172 unvaccinated children contracted influenza (66%, 9—88, p=0·03). We were unable to record any adverse events associated with the vaccination of the children in our study. Interpretation. Trivalent inactivated influenza vaccine was effective in preventing influenza in young children, including those younger than 2 years. Our findings suggest that influenza vaccine recommendations should be reassessed in most countries.

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Modeling the cost of influenza: the impact of missing costs of unreported complications and sick leave
Xue Y, Sonobo Kristiansen I, Freiesleben de Blasio B. BMC Public Health. 24 November 2010;10:724. doi:10.1186/1471-2458-10-724.
Available at http://www.biomedcentral.com/1471-2458/10/724

Background. Estimating the economic impact of influenza is complicated because the disease may have non-specific symptoms, and many patients with influenza are registered with other diagnoses. Furthermore, in some countries like Norway, employees can be on paid sick leave for a specified number of days without a doctor's certificate ("self-reported sick leave") and these sick leaves are not registered. Both problems result in gaps in the existing literature: costs associated with influenza-related illness and self-reported sick leave are rarely included. The aim of this study was to improve estimates of total influenza-related health-care costs and productivity losses by estimating these missing costs.

Methods. Using Norwegian data, the weekly numbers of influenza-attributable hospital admissions and certified sick leaves registered with other diagnoses were estimated from influenza-like illness surveillance data using quasi-Poisson regression. The number of self-reported sick leaves was estimated using a Monte-Carlo simulation model of illness recovery curves based on the number of certified sick leaves. A probabilistic sensitivity analysis was conducted on the economic outcomes.

Results. During the 1998/99 through 2005/06 influenza seasons, the models estimated an annual average of 2700 excess influenza-associated hospitalizations in Norway, of which 16% were registered as influenza, 51% as pneumonia and 33% were registered with other diagnoses. The direct cost of seasonal influenza totaled US$22 million annually, including costs of pharmaceuticals and outpatient services. The annual average number of working days lost was predicted at 793 000, resulting in an estimated productivity loss of US$231 million. Self-reported sick leave accounted for approximately one-third of the total indirect cost. During a pandemic, the total cost could rise to over US$800 million.

Conclusions. Influenza places a considerable burden on patients and society with indirect costs greatly exceeding direct costs. The cost of influenza-attributable complications and the cost of self-reported sick leave represent a considerable part of the economic burden of influenza.

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Influenza Vaccine — Safe, Effective, and Mistrusted
Harris KM, Maurer J, Kellermann AL. New Eng. Jour. Med. 24 November 2010. 10.1056/NEJMp1012333.
Available at http://www.nejm.org/doi/full/10.1056/NEJMp1012333

Introduction. On August 10, 2010, the World Health Organization (WHO) declared an end to the 2009 influenza A (H1N1) pandemic. It is fortunate that the virus that had spread worldwide so quickly turned out to be less severe than was first feared. It is worth remembering, though, that an earlier strain of H1N1 influenza — the one that emerged in 1918 — sparked the worst closely observed and recorded pandemic in history, killing an estimated 20 million to 40 million people worldwide.

The 2009 H1N1 virus did give us one gift of inestimable value: it provided a full-scale test of the ability of the United States to counter pandemic influenza. If we draw the right lessons from the response, we can considerably strengthen our country's public health preparedness.

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Comparison of Pandemic and Seasonal Influenza Reveals Higher Mortality and Increased Prevalence of Shock in Children With Severe H1N1/09 Infection
Lippincott Williams & Wilkins. Ped. Infect. Dis. Journal. 22 November 2010. doi: 10.1097/INF.0b013e3182040c90.
Available at http://journals.lww.com/pidj/Abstract/publishahead/Comparison_of_Pandemic_and_Seasonal_Influenza.99135.aspx

Abstract. Comparison of the clinical features of H1N1/09 and previous years' influenza A cases reveals that, in children presenting with severe disease, H1N1/09 influenza is associated with an increased prevalence of shock, duration of admission, and mortality. This was not attributable to demographic differences or underlying disease. H1N1/09 influenza is associated with more severe diseases than those with previous years' influenza A strains.

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The Impact of the H1N1 Pandemic on Canadian Hospitals
Canadian Institute for Health Information. The Impact of the H1N1 Pandemic on Canadian Hospitals. November 2010.
Available at http://secure.cihi.ca/cihiweb/products/H1N1_AIB_final_EN.pdf

Excerpt. Pandemic planning is a critical function for any health system. These plans aim to limit serious illness and death from a pandemic; they also ensure that essential health services are maintained and disruption of other health services is minimized. Achieving the goals of a pandemic plan requires the coordination of many agencies and institutions, from public health to acute care hospitals, and requires the cooperation of sub-national, national and international partners.

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Rapid detection of pandemic influenza in the presence of seasonal influenza
Singh BK, Savill NJ, Ferguson NM, et al. BMC Public Health. 24 November 2010;10:726. doi:10.1186/1471-2458-10-726.
Available at http://www.biomedcentral.com/1471-2458/10/726

Background. Key to the control of pandemic influenza are surveillance systems that raise alarms rapidly and sensitively. In addition, they must minimise false alarms during a normal influenza season. We develop a method that uses historical syndromic influenza data from the existing surveillance system 'SERVIS' (Scottish Enhanced Respiratory Virus Infection Surveillance) for influenza-like illness (ILI) in Scotland.

Methods. We develop an algorithm based on the weekly case ratio (WCR) of reported ILI cases to generate an alarm for pandemic influenza. From the seasonal influenza data from 13 Scottish health boards, we estimate the joint probability distribution of the country-level WCR and the number of health boards showing synchronous increases in reported influenza cases over the previous week. Pandemic cases are sampled with various case reporting rates from simulated pandemic influenza infections and overlaid with seasonal SERVIS data from 2001 to 2007. Using this combined time series we test our method for speed of detection, sensitivity and specificity. Also, the 2008-09 SERVIS ILI cases are used for testing detection performances of the three methods with a real pandemic data.

Results. We compare our method, based on our simulation study, to the moving-average Cumulative Sums (Mov-Avg Cusum) and ILI rate threshold methods and find it to be more sensitive and rapid. For 1% case reporting and detection specificity of 95%, our method is 100% sensitive and has median detection time (MDT) of 4 weeks while the Mov-Avg Cusum and ILI rate threshold methods are, respectively, 97% and 100% sensitive with MDT of 5 weeks. At 99% specificity, our method remains 100% sensitive with MDT of 5 weeks. Although the threshold method maintains its sensitivity of 100% with MDT of 5 weeks, sensitivity of Mov-Avg Cusum declines to 92% with increased MDT of 6 weeks. For a two-fold decrease in the case reporting rate (0.5%) and 99% specificity, the WCR and threshold methods, respectively, have MDT of 5 and 6 weeks with both having sensitivity close to 100% while the Mov-Avg Cusum method can only manage sensitivity of 77% with MDT of 6 weeks. However, the WCR and Mov-Avg Cusum methods outperform the ILI threshold method by 1 week in retrospective detection of the 2009 pandemic in Scotland.

Conclusions. While computationally and statistically simple to implement, the WCR algorithm is capable of raising alarms, rapidly and sensitively, for influenza pandemics against a background of seasonal influenza. Although the algorithm was developed using the SERVIS data, it has the capacity to be used at other geographic scales and for different disease systems where buying some early extra time is critical.

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Avian influenza research by FAO and partners focused on China’s Qinghai Lake
World Organisation for Animal Health, European Commission, et al. FAOAIDEnews Animal Influenza Disease Emergency.16 November 2010. 71:2-3.
Available at http://www.fao.org/docrep/013/al835e/al835e00.pdf

Excerpt: The emergence of highly pathogenic avian influenza (H5N1 HPAI) has wreaked havoc in avian (domestic and wild) and human populations. According to the World Health Organization, since 2003, H5N1 HPAI has killed 302 people, including 20 so far this year. It is estimated that more than 250 million infected domestic poultry have been culled in Southeast Asia. For the most part, H5N1 HPAI has been held in check by early detection, early reporting, rapid response, improved disease surveillance, better husbandry practices, poultry vaccinations, and other disease mitigation measures, but still, so far this year, 16 countries report viral outbreaks in poultry.

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5. Notifications
APEC Hot Topics Videoconference
Videoconference, 2 December 2010 (3 December 2010 in Asian countries)
The next APEC Hot Topics Videoconference will convene APEC countries in discussing emerging infectious diseases as a result of climate change and natural disasters. APEC countries are invited to participate.
Additional information available by emailing apecein@u.washington.edu

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Cell Symposia – Influenza: Translating Basic Insights
Washington DC, USA 2-4 December 2010
This meeting will foster interactions among scientists studying the influenza virus from the perspective of the virus itself, host response to viral infection, clinical manifestations, as well as vaccine and therapeutic approaches.
Organized by: Cell Press - Sponsor Journal - Cell Host and Microbe
Additional information available at http://www.cell-symposia-influenza.com/index.asp

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

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Keystone Symposia: Tuberculosis: Immunology, Cell Biology and Novel Vaccination Strategies
Vancouver, British Columbia, Canada 15-20 January 2011
This Keystone Symposium on TB will focus on these relationships covering basic and clinical research. Topics include the molecular genetics and biochemistry of the pathogen with emphasis on unique lineage and growth state-specific features.
Additional information at http://www.keystonesymposia.org/11J3

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 apecein@u.washington.edu