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Vol. XIII No. 26 ~ EINet News Briefs ~ Dec 23, 2010
*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and
notifications for emerging infections affecting the APEC member economies. It
was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
1. Influenza News
- 2010 Cumulative number of human cases of avian influenza A/H5N1
- Global: Influenza worries, activity reported in UK, Israel
- Global: Influenza season under way in Northern Hemisphere
- Global: Countries reporting H1N1 influenza activity
- UK: Increased influenza activity prompts warnings in Northern Ireland, Wales
- UK: Leads way as influenza activity rises in Europe
- Switzerland: Army recruits test positive for H1N1 influenza
- South Korea: H1N1 influenza hits southern schools
- USA: Influenza activity slows in southeastern hot spot
- Egypt: Four dead, 19 infected with H1N1 influenza in nine governorates
- Egypt: 114th case of H5N1 avian influenza
2. Infectious Disease News
- Global: WHO reports malaria control progress
- China (Guangdong): Thirty-three people died of rabies
- Canada (Nunavut territory): TB cases spike
- United States (New York, California): Health agency warns of whooping cough outbreak, urges visitors to get vaccination
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- VECTOR-BORNE DISEASE
- A high-resolution human contact network for infectious disease transmission
- A pandemic influenza preparedness study: Use of energetic methods to decontaminate filtering facepiece respirators contaminated with H1N1 aerosols and droplets
- Barriers to Mask Wearing for Influenza-like Illnesses Among Urban Hispanic Households
- Perspective: Swine-Origin Influenza: 1976 and 2009
- The Science behind Preparing and Responding to Pandemic Influenza: The Lessons and Limits of Science
- Epidemiology of 2009 Pandemic Influenza A (H1N1) in the United States
- Hospitalized Patients with 2009 Pandemic Influenza A (H1N1) Virus Infection in the United States—September–October 2009
- Epidemiology of 2009 Pandemic Influenza A (H1N1) Deaths in the United States, April–July 2009
- Pandemic Influenza A (H1N1) Deaths among Children—United States, 2009–2010
- Estimating the Burden of 2009 Pandemic Influenza A (H1N1) in the United States (April 2009–April 2010)
- Influenza-Like Illness in a Community Surrounding a School-Based Outbreak of 2009 Pandemic Influenza A (H1N1) Virus–Chicago, Illinois, 2009
- Transmission of 2009 Pandemic Influenza A (H1N1) at a Public University—Delaware, April–May 2009
- Non-Pharmaceutical Interventions during an Outbreak of 2009 Pandemic Influenza A (H1N1) Virus Infection at a Large Public University, April–May 2009
- Household Transmission of 2009 Pandemic Influenza A (H1N1) and Nonpharmaceutical Interventions among Households of High School Students in San Antonio, Texas
- Investigating 2009 Pandemic Influenza A (H1N1) in US Schools: What Have We Learned?
- A Model Survey for Assessing 2009 Pandemic Influenza A (H1N1) Virus Disease Burden in the Workplace
- Transmission of Pandemic (H1N1) 2009 Influenza to Healthcare Personnel in the United States
- Hospitalized Children with 2009 Pandemic Influenza A (H1N1): Comparison to Seasonal Influenza and Risk Factors for Admission to the ICU
- The effect of influenza vaccination on risk of acute myocardial infarction: Self-controlled case-series study
- Serologic Status for Pandemic (H1N1) 2009 Virus, Taiwan
- Pandemic H1N1 in Children Requiring Intensive Care in Australia and New Zealand During Winter 2009
- Influenza Pandemic Waves under Various Mitigation Strategies with 2009 H1N1 as a Case Study
- Spatio-Temporal Data Comparisons for Global Highly Pathogenic Avian Influenza (HPAI) H5N1 Outbreak
- Keystone Symposia: Tuberculosis: Immunology, Cell Biology and Novel Vaccination Strategies
- CDC updates guidance on rapid flu tests
- Designing Climate Change Adaptation Initiatives
1. Influenza News
2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Cambodia / 1 (1)
China / 2 (1)
Egypt / 23 (10)
Indonesia / 9 (7)
Viet Nam 7 (2)
Total / 42 (21)
***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: 510 (303) (WHO 12/9/10)
Avian influenza age distribution data from WHO/WPRO (last updated 11/19/10):
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 12/9/10):
Global: Influenza worries, activity reported in UK, Israel
British general practitioners (GPs) are deeply concerned that a major flu crisis is brewing winter 2010 and are calling on the government to step up the public awareness campaign for seasonal flu immunization, the British Medical Association (BMA) said on 17 December 2010. Physicians are concerned about a low immunization rate in their high-risk patients and that this could make the 2010 flu season worse. Dr. Laurence Buckman, chair of the BMA's GP Committee, urges an increase in publicity about the safety and effectiveness of the vaccine. Meanwhile, 30 Israeli soldiers who were taking an officers' course in Jerusalem were hit by the H1N1 virus the week of 12 December 2010. They were said to be in good condition. In other developments, the US Centers for Disease Control and Prevention stated on 17 December 2010 that flu activity was still low in most regions, but Russia had "medium intensity activity." Most of the flu viruses tested in Canada and China so far were H3N2 strains. In contrast, 2009 H1N1 and type B have predominated in the United Kingdom and other European countries so far.
Global: Influenza season under way in Northern Hemisphere
The World Health Organization (WHO) said that the season is starting in some Northern Hemisphere locations such as the East Asia, North America, and most notably the United Kingdom. England is seeing co-circulation of 2009 H1N1 and influenza B viruses, with an increasing number of severe flu cases. Data show the 2009 H1N1 strain is epidemiologically and virologically similar to the strain during the 2009 influenza H1N1 pandemic. A genetic analysis of H1N1 samples from England shows several genetic substitutions compared with the vaccine virus, but the WHO said they don't affect the antigenicity of the virus and are similar to changes that have already been detected in other parts of the world. Small to moderate increases in flu-like illnesses have been noted in 14 European countries, especially in children, with activity rising above baselines in the Russian Federation and the Ukraine. In East Asia, flu activity has recently increased in Mongolia and South Korea, and to a lesser extent, northern China. In tropical countries flu activity is low, except for Sri Lanka, where 2009 H1N1 activity recently peaked. Little flu activity has been reported in sub-Saharan Africa, except for Cameroon, which reported a recent surge in 2009 H1N1 infections.
Global: Countries reporting H1N1 influenza activity
Egypt's health ministry said it received reports of 218 cases of 2009 H1N1 flu the week of 12 December 2010, bringing the country's total to 533, including 30 deaths, since October 2010. Abdel Rahman Shahin, ministry spokesman, said the rate is normal for seasonal influenza and should rise as outdoor temperatures cool. The 2009 H1N1 activity in Egypt is an example of periodic outbreaks of the virus that the World Health Organization (WHO) said it expected to see in the post-pandemic phase. In England, which has also reported a spike in 2009 H1N1 infections, a spokeswoman for the health department said on 21 December 2010 that 302 people are being treated in intensive care units for influenza infections. Elsewhere, Sri Lanka's health ministry issued on 20 December 2010 an alert advising pregnant women, healthcare workers, transportation employees, armed forces, and law enforcement personnel to get vaccinated against the 2009 H1N1 virus as a precaution. The WHO said that 2009 H1N1 activity had recently peaked in Sri Lanka, one of the few tropical countries reporting flu transmission. Dr. Sudath Peiris, a senior epidemiologist at the health ministry, said Sri Lanka had already distributed the 400,000 doses of 2009 H1N1 vaccine from the WHO and is requesting one million more.
UK: Increased influenza activity prompts warnings in Northern Ireland, Wales
Authorities in Northern Ireland and Wales are urging people to get influenza shots amid signs of more flu activity. The Public Health Agency for Northern Ireland has issued a warning about H1N1 flu and urged all pregnant women to be vaccinated, following the deaths of three pregnant women. In Wales, a flu outbreak was reported on 15 December 2010 at the Cathedral School in Cardiff, with 120 children sick and three confirmed H1N1 cases. Welsh health officials are concerned about low uptake of flu vaccine, especially among pregnant women. By the end of November 2010, vaccine coverage was 52% in people 65 and older and 34% among younger people at risk for flu complications. Flu-like illness cases have increased sharply in the week that ended 11 December 2010 in Wales and across the United Kingdom.
UK: Leads way as influenza activity rises in Europe
The United Kingdom is on the leading edge of an increase in influenza activity in Europe, with 57 respiratory disease outbreaks and an increase in critically ill patients and deaths reported in the country the week of 5 December 2010, according to the UK Health Protection Agency (HPA). The HPA said the rate of medical visits for flu-like illness exceeded baseline levels, reaching 34.6 per 100,000 population. The 2009 H1N1 and influenza B viruses are predominating so far this season, with only a few H3N2 viruses identified.
Flu activity is also rising across Europe, with increasing transmission in 11 countries, the European Centre For Disease Prevention and Control (ECDC) said on 16 December 2010.
In the United Kingdom, of 17 people who have died of flu-related causes between 16 September 2010 and 16 December 2010, seven deaths were reported the week of 5 December 2010, according to HPA. Fourteen of the deaths were attributed to the 2009 H1N1 virus. All those who died were younger than 65, and eight were in high-risk groups, though none were pregnant. Seventeen critically ill patients have received extracorporeal membrane oxygenation (ECMO) (the use of an artificial lung), out of 22 patients referred for it, the HPA reported. Four of the 17 were pregnant women.
Meanwhile, press reports suggested that flu activity in parts of Britain now is worse than at the peak of the 2009 pandemic, but a health official said the flu situation is no worse than in past years before 2010.
Northwestern England has seen a surge of hospitalized flu patients between 6 December 2010 and 15 December 2010 and that the numbers are higher than at the peak of the pandemic. It said five deaths were reported in the region on 15 December 2010. Intensive care specialists are saying that the National Health Service is under more pressure than it was in 2009.
In addition, public health specialists called the flu situation in northeastern England as bad as or worse than at the peak of the pandemic. The number of severely ill patients has surprised specialists, because monitoring has indicated low levels of H1N1 flu in the community.
Bob Winter, president of the UK Intensive Care Society, said that something different is happening in 2010. There was a sudden surge of activity between 6 December 2010 and 15 December 2010. The numbers in intensive care are increasing across the UK. He said that this is emerging as a serious issue."
However, Dame Sally Davies, interim chief medical officer for England, said that flu is not more prevalent now than at the same time in previous years before 2010. Davies added that the 35 medical visits for flu-like illness per 100,000 people in the week of 5 December 2010 is up from 13 per 100,000 the week of 28 November 2010, and she said that the issue she’s very concerned about is they're not getting everyone at risk—including pregnant women—vaccinated.
HPA said that flu vaccine uptake in England as of 2 December 2010 was 67.2% for people older than 65 and 41.6% for high-risk people younger than 65. Of 355 respiratory samples that tested positive for flu during the week of 5 December 2010, 271 (76.3%) were the 2009 H1N1 virus, 77 (21.7%) were type B, and 7 (2.0%) were type A strains that were not subtyped.
Similarly, ECDC said on 16 December 2010 that most of the flu viruses circulating in Europe are H1N1 and influenza B. Although the majority of cases in the UK are mild, a significant number of severe hospitalized cases and several deaths have occurred. In the past, epidemics have most often progressed from west to east in Europe. Limited time remains for public health and clinical interventions to reduce the impact of flu during the winter of 2010. There is strong evidence that the 2010 vaccine will be "highly effective" against the H1N1 virus.
Switzerland: Army recruits test positive for H1N1 influenza
Nearly 100 Swiss Army recruits near St. Gallen contracted varied forms of the flu between 17 December 2010 and 19 December 2010, with six confirmed cases of the H1N1 virus, or swine flu. Sixty-six recruits were admitted to a military hospital. The recruits were segregated from other patients, though the Ministry of Defense said such flu epidemics are not uncommon for the winter season.
(World Radio Switzerland 12/20/2010)
South Korea: H1N1 influenza hits southern schools
The influenza A (H1N1) virus, which swept the world in 2009, has returned as the weather has become colder, forcing an elementary school in the southeastern area to be closed.
A group of children at an elementary school in Daejeon were found to have been infected by the virus. A total of 16 students in fifth and sixth grades suffered from fever and tested positive for influenza A on 10 December 2010.
A school in Pohang, North Gyeongsang Province, also closed its doors as a student was confirmed to be infected with the disease and another 100 students showed flu symptoms.
Health authorities said the flu is unlikely to be fatal but stressed that people should have flu shots and wash their hands regularly. The number of reported flu cases is about one tenth of 2009 but children, the elderly and the physically-weak need to get flu shots as preventive measures, an official from the Health and Welfare Ministry said.
(The Korean Times 12/12/2010)
USA: Influenza activity slows in southeastern hot spot
Flu activity in southeastern US states, a region that recently reported increases, declined the week of 28 November 2010, falling back below seasonal baseline levels, the Centers for Disease Control and Prevention (CDC) said on 10 December 2010. Such rises and falls aren't unusual, and flu activity typically peaks in January or later. Activity is low across the rest of the nation, with Georgia, Kentucky, and Virginia reporting regional activity. Other flu indicators also pointed to low activity. The percentage of respiratory specimens testing positive for influenza stayed about the same as the week of 28 November 2010, at 10.8%. Doctor's visits for flu-like illnesses were below the national baseline, and deaths from flu and pneumonia were below the epidemic threshold. Most of the flu viruses circulating are the influenza A (H3N2) and B strains. Tests show that all three circulating strains match well with those included in the seasonal flu vaccine, including pandemic 2009 H1N1.
Egypt: Four dead, 19 infected with H1N1 influenza in nine governorates
Four deaths associated with the H1N1 virus, commonly known as "swine flu," were reported the week of 19 December 2010 countrywide, while the number of people diagnosed with the virus reached 19 throughout nine governorates of Egypt. There are an additional 31 suspected cases.
(Al-Masry Al-Youm 12/21/2010)
Egypt: 114th case of H5N1 avian influenza
Ministry of Health spokesman Abdel Rahman Shahin announced the discovery of the latest case of bird flu, afflicting a 25-year-old woman in Beheira governorate. The unnamed woman constitutes the 114th case of bird flu since the onset of the disease in Egypt.
Shaheen noted that the woman entered a local hospital with a high fever and flu symptoms after being exposed to household birds suspected of carrying the disease. The spokesperson further added that medical examinations found her suffering from pulmonary tuberculosis. She is currently stable after being administered a dose of the drug Tamiflu.
2. Infectious Disease News
Global: WHO reports malaria control progress
Malaria control programs are showing steady progress toward international goals, such as providing anti-malarial interventions to all who need them, the World Health Organization (WHO) said on 14 December 2010. The WHO said a massive boost in malaria control efforts since 2008 has provided 578 million people in sub-Saharan Africa with insecticide-treated mosquito nets and protected 78 million people with indoor residual spraying, which represents 10% of the at-risk population. Eleven African countries reported greater than 50% decreases in malaria cases and deaths over the past decade, and 32 of 56 endemic countries outside Africa reported more than 50% drops in confirmed cases. Dr. Margaret Chan, the WHO's director-general, stated that the reported results are the best seen in decades. However, the WHO noted that malaria control is fragile in some areas, with resurgences in cases noted in Rwanda, Sao Tome, and Zambia. More work needs to be done to reach international targets. Though funding for control efforts rose to a record $1.5 billion in 2009, new financial commitments in 2010 appear to have leveled off. In a related development, three groups announced today that they are collaborating on a new approach for preventing malaria with a vaccine, according to a press release today from Merck, one of the groups. The other two collaborators are the Seattle-based PATH Malaria Vaccine Initiative and New York University Langone Medical Center. The new approach attempts to prevent the malaria parasite from entering the liver. The group is focusing on a region of the circumsporozoite protein, which would block the parasite from invading the liver. The new approach requires lower antibody levels than other strategies that target the protein. So far, it is being testing in children younger than 1 year old, but researchers hope it can be adapted for other patient populations and Plasmodium species.
China (Guangdong): Thirty-three people died of rabies
The Guangdong Provincial Health Bureau announced infectious disease information on 22 December 2010. A total of 33 people died of rabies across the province in November 2010. Experts remind people to guard against bites from dogs and cats, and to seek prompt medical attention if bitten.
[ProMED note: The ranking of rabies as the second highest cause of mortality from infectious disease in Guangdong province, second only to AIDS, is a striking statistic emphasizing a need for enhanced control of this disease by animal vaccination and better availability of post-exposure prophylaxis for humans.]
Canada (Nunavut territory): TB cases spike
Health officials in Canada's Arctic Nunavut territory are fighting a rise in tuberculosis (TB) cases, 98 of which have been confirmed for 2010, the most in the territory's 11-year-history, as reported on 12 December 2010. The area's TB rate is 62 times higher than Canada's national average. Dr. Pamela Orr, an aboriginal disease expert at the University of Manitoba, said that the Nunavut, hit badly by the disease in the 1950s, has a high percentage of middle-aged and older residents who have latent infections from inadequately treated past disease. She said poor living conditions and latent disease provide fertile ground for such a TB outbreak. The Nunavut government is urging people to complete their antibiotic treatment by offering fast food incentives, and Health Canada has spent $9.6 million fighting the disease in 2009. Health officials are weighing other options for responding to the outbreak, such as a massive effort to improve socioeconomic conditions and a more aggressive antibiotic treatment strategy.
United States (New York, California): Health agency warns of whooping cough outbreak, urges visitors to get vaccination
The Public Health Agency of Canada is warning U.S.-bound travelers to be on guard against whooping cough, which is also known as pertussis. Public health officials warn that pertussis, or whooping cough, can be particularly serious in infants and children. Outbreaks of the illness have been reported in New York State and California.
The California Department of Public Health (CDPH) says the outbreak in that state has reached epidemic levels, with 7,297 cases, including ten deaths, nine of them in infants under two months old.
Dr. Gilberto Chavez, the chief of the CDPH's Centre for Infectious Disease and the state's epidemiologist, stated that 2011 could be the worst year for pertussis that California has seen in more than 50 years. Another outbreak in Jefferson County, N.Y., has resulted in 463 confirmed cases, six of which required hospitalization. Jefferson County is on the southern banks of Lake Ontario, near Buffalo and Niagara Falls.
Pertussis is highly contagious. It spreads through droplets in the air from coughing or sneezing. It can cause coughing spells that last from four to six weeks. While it can infect people of any age, it's particularly serious in young children. Major complications include hypoxia or lack of oxygen, inability to breath, pneumonia and neurological complications such as seizures. Canadian infants are routinely vaccinated against pertussis. However, some parents decline to get their children vaccinated because of a general fear of potential side-effects of vaccines.
The Public Health Agency of Canada urges anyone traveling to affected regions to ensure their vaccinations are up to date. Adults who have not been vaccinated are encouraged to visit a doctor or travel clinic and ask for a Tdap vaccination.
(CBC News 12/21/2010)
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
Eastern Mediterranean: http://www.emro.who.int/csr/h1n1/
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
WHO H1N1 pandemic influenza update 115: http://www.who.int/csr/don/2010_08_27/en/index.html
CDC Teleconference results: Healthcare groups need to share emergency plans: http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/sep0210standards.html
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.
Australian health authorities said that there have been more than 430 reports of dengue infections as of 17 December 2010, most associated with the Indonesian island of Bali. This is more than treble the 130 cases in 2009 and compares with 95 cases in 2008 and 55 cases in 2007.
(The West Australian 12/17/2010)
The city of Hermosillo has had a severe water shortage crisis, leading thousands of families to find alternative recipients for water storage. The average number of recipients to store water is 13 per household. Water tanks in homes could be the reason for the increase in dengue cases because of vector mosquito breeding sites. The dengue outbreak has caused 3,157 cases in the state, of which 2,744 were in Hermosillo, where three deaths have been confirmed. Since 1982, when Hermosillo had about 3,000 cases of dengue, the numbers had not shot up like in 2010, where during the week 12 December 2010, 55 cases were added to the total of 2,744 cases.
A high-resolution human contact network for infectious disease transmission
Salathe M, Kazandijieva M, Lee JW, et al. Proc Natl Acad Sci. 13 December 2010. doi: 10.1073/pnas.1009094108.
Available at http://www.pnas.org/content/early/2010/12/08/1009094108.abstract
Abstract. The most frequent infectious diseases in humans—and those with the highest potential for rapid pandemic spread—are usually transmitted via droplets during close proximity interactions (CPIs). Despite the importance of this transmission route, very little is known about the dynamic patterns of CPIs. Using wireless sensor network technology, we obtained high-resolution data of CPIs during a typical day at an American high school, permitting the reconstruction of the social network relevant for infectious disease transmission. At 94% coverage, we collected 762,868 CPIs at a maximal distance of 3 m among 788 individuals. The data revealed a high-density network with typical small-world properties and a relatively homogeneous distribution of both interaction time and interaction partners among subjects. Computer simulations of the spread of an influenza-like disease on the weighted contact graph are in good agreement with absentee data during the most recent influenza season. Analysis of targeted immunization strategies suggested that contact network data are required to design strategies that are significantly more effective than random immunization. Immunization strategies based on contact network data were most effective at high vaccination coverage.
A pandemic influenza preparedness study: Use of energetic methods to decontaminate filtering facepiece respirators contaminated with H1N1 aerosols and droplets
Heimbuch BK, Wallace WH, Kinney K, et al. Am J of Infect Control. 10 December 2010 (10.1016/j.ajic.2010.07.004).
Available at http://www.ajicjournal.org/article/S0196-6553(10)00814-X/abstract
Background. A major concern among health care experts is a projected shortage of N95 filtering facepiece respirators (FFRs) during an influenza pandemic. One option for mitigating an FFR shortage is to decontaminate and reuse the devices. Many parameters, including biocidal efficacy, filtration performance, pressure drop, fit, and residual toxicity, must be evaluated to verify the effectiveness of this strategy. The focus of this research effort was on evaluating the ability of microwave-generated steam, warm moist heat, and ultraviolet germicidal irradiation at 254 nm to decontaminate H1N1 influenza virus.
Methods. Six commercially available FFR models were contaminated with H1N1 influenza virus as aerosols or droplets that are representative of human respiratory secretions. A subset of the FFRs was treated with the aforementioned decontamination technologies, whereas the remaining FFRs were used to evaluate the H1N1 challenge applied to the devices.
Results. All 3 decontamination technologies provided >4-log reduction of viable H1N1 virus. In 93% of our experiments, the virus was reduced to levels below the limit of detection of the method used.
Conclusions. These data are encouraging and may contribute to the evolution of effective strategies for the decontamination and reuse of FFRs
Barriers to Mask Wearing for Influenza-like Illnesses Among Urban Hispanic Households
Ferng Y-H, Wong-McLoughlin J, Barrett A, et al. Public Health Nursing. 15 December 2010. doi: 10.1111/j.1525-1446.2010.00918.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1446.2010.00918.x/abstract
Objectives. To identify barriers to mask wearing and to examine the factors associated with the willingness to wear masks among households.
Design and Sample. We used data sources from a study assessing the impact of 3 nonpharmaceutical interventions on the rates of influenza: exit interviews; home visits with a subset of the mask group; and a focus group.
Measures. Risk perception score, univariate analysis, and logistic regression were conducted to identify the characteristics and predictors of mask use. Thematic barriers to mask wearing were identified from qualitative data obtained at home visits and focus group.
Results. Respondents from the mask group, when compared with the nonmask group, demonstrated higher risk perception scores concerning influenza (maximum score: 60, means: 37.6 and 30.2, p<.001) and increased perception of effectiveness of mask wearing (maximum score: 10, means: 7.8 and 7.3, p=.043). There was no significant association between demographic, attitudinal, or knowledge variables and adherence to wearing masks. Thematic barriers were identified such as social acceptability of mask use, comfort and fit, and perception of the risk/need for masks.
Conclusions. Face masks may not be an effective intervention for seasonal or pandemic influenza unless the risk perception of influenza is high. Dissemination of culturally appropriate mask use information by health authorities and providers must be emphasized when educating the public.
Perspective: Swine-Origin Influenza: 1976 and 2009
Sencer DJ. Clin Infect Dis. 14 December 2010;52 (suppl 1): S4-S7.doi: 10.1093/cid/ciq006.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S4.full
Abstract. I am in a unique situation, having been involved in 2 major US public health events resulting from novel swine-origin influenza viruses. In 1976, I was Director of the Center for Disease Control (CDC, the name of the agency at the time) when a new influenza virus, characterized as an influenza A(H1N1) swine virus, was isolated from military recruits at Fort Dix, New Jersey. Subsequently, I led the CDC through the US response to this outbreak, which culminated in the decision to implement the swine flu vaccination program during which 45 million people were vaccinated over 10 weeks. The program was stopped after cases of Guillain-Barré Syndrome were identified following vaccination and when no spread of the virus occurred beyond Fort Dix. In 2009, as another new swine H1N1 virus was first identified and emergency response began, I was asked to be an advisor to the CDC Director in order that I might provide historical context to the novel H1N1 swine-origin outbreak and response. In this latter capacity, I have been able to observe and participate in discussions resulting in decision-making for the CDC’s national response to this public health emergency as an unpaid consultant. This paper is a personal commentary on the similarities and dissimilarities of the 2 episodes.
The Science behind Preparing and Responding to Pandemic Influenza: The Lessons and Limits of Science
Schuchat A, Bell BP, Redd SC. Clin Infect Dis. 14 December 2010;52 (suppl 1): S8-S12.doi: 10.1093/cid/ciq007.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S8.full
Abstract. A strong evidence base provides the foundation for planning and response strategies. Investments in pandemic preparedness included support for research that aided early detection, response, and control of the 2009 influenza A (H1N1) (pH1N1) pandemic. Scientific investigations conducted during the pandemic guided understanding of the virus, disease severity, and epidemiologic risk factors. Field investigations also produced information that strengthened guidance for the use of antivirals, identification of target populations for monovalent pH1N1 vaccine, and refinement of recommendations for social distancing measures. Communication of this evolving evidence base was important to sustaining credibility of public health. Areas where substantial controversy emerged, such as the optimal approach to respiratory protection of healthcare workers, often suffered from gaps in the evidence base. Many aspects of the 2009–2010 pandemic influenza experience provide ongoing opportunities for additional study, which will strengthen plans for future pandemic response as well as control of seasonal influenza.
Epidemiology of 2009 Pandemic Influenza A (H1N1) in the United States
Jhung MA, Swerdlow D, Olsen SJ, et al. Clin Infect Dis. 14 December 2010.;52 (suppl 1): S13-S26.doi: 10.1093/cid/ciq008.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S13.full
Abstract. In April 2009, the Centers for Disease Control and Prevention confirmed 2 cases of 2009 pandemic influenza A (H1N1) virus infection in children from southern California, marking the beginning of what would be the first influenza pandemic of the twenty-first century. This report describes the epidemiology of the 2009 H1N1 pandemic in the United States, including characterization of cases, fluctuations of disease burden over the course of a year, the age distribution of illness and severe outcomes, and estimation of the overall burden of disease.
Hospitalized Patients with 2009 Pandemic Influenza A (H1N1) Virus Infection in the United States—September–October 2009
Skarbinski J, Jain S, Bramley A, et al. Clin Infect Dis. 14 December 2010.;52 (suppl 1): S50-S59.doi: 10.1093/cid/ciq021.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S50.full
Abstract. Given the potential worsening clinical severity of 2009 pandemic influenza A (H1N1) virus (pH1N1) infection from spring to fall 2009, we conducted a clinical case series among patients hospitalized with pH1N1 infection from September through October 2009. A case patient was defined as a hospitalized person who had test results positive for pH1N1 virus by real-time reverse-transcription polymerase chain reaction. Among 255 hospitalized patients, 34% were admitted to an intensive care unit and 8% died. Thirty-four percent of patients were children <18 years of age, 8% were adults ≥65 years of age, and 67% had an underlying medical condition. Chest radiographs obtained at hospital admission that had findings that were consistent with pneumonia were noted in 103 (46%) of 255 patients. Among 255 hospitalized patients, 208 (82%) received neuraminidase inhibitors, but only 47% had treatment started ≤2 days after illness onset. Overall, characteristics of hospitalized patients with pH1N1 infection in fall 2009 were similar to characteristics of patients hospitalized with pH1N1 infection in spring 2009, which suggests that clinical severity did not change substantially over this period.
Epidemiology of 2009 Pandemic Influenza A (H1N1) Deaths in the United States, April–July 2009
Fowlkes AL, Arguin P, Biggerstaff M, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S60-S68.doi: 10.1093/cid/ciq022.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S60.full
Abstract. During the spring of 2009, pandemic influenza A (H1N1) virus (pH1N1) was recognized and rapidly spread worldwide. To describe the geographic distribution and patient characteristics of pH1N1-associated deaths in the United States, the Centers for Disease Control and Prevention requested information from health departments on all laboratory-confirmed pH1N1 deaths reported from 17 April through 23 July 2009. Data were collected using medical charts, medical examiner reports, and death certificates. A total of 377 pH1N1-associated deaths were identified, for a mortality rate of .12 deaths per 100 000 population. Activity was geographically localized, with the highest mortality rates in Hawaii, New York, and Utah. Seventy-six percent of deaths occurred in persons aged 18–65 years, and 9% occurred in persons aged ≥65 years. Underlying medical conditions were reported for 78% of deaths: chronic lung disease among adults (39%) and neurologic disease among children (54%). Overall mortality associated with pH1N1 was low; however, the majority of deaths occurred in persons aged <65 years with underlying medical conditions.
Pandemic Influenza A (H1N1) Deaths among Children—United States, 2009–2010
Cox CM, Blanton L, Dhara R, et al. Clin Infect Dis. 14 December 2010. 52 (suppl 1): S69-S74.doi: 10.1093/cid/ciq011.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S69.full
Abstract. The 2009 pandemic influenza A (H1N1) (pH1N1) virus emerged in the United States in April 2009 (1) and has since caused significant morbidity and mortality worldwide (2–6). We compared pandemic influenza A (H1N1) (pH1N1)–associated deaths occurring from 15 April 2009 through 23 January 2010 with seasonal influenza–associated deaths occurring from 1 October 2007 through 14 April 2009, a period during which data collected were most comparable. Among 317 children who died of pH1N1-associated illness, 301 (95%) had a reported medical history. Of those 301, 205 (68%) had a medical condition associated with an increased risk of severe illness from influenza. Children who died of pH1N1-associated illness had a higher median age (9.4 vs 6.2 years; P<.01) and longer time from onset of symptoms to death (7 vs 5 days, P<.01) compared with children who died of seasonal influenza–associated illness. The majority of pediatric deaths from pH1N1 were in older children with high-risk medical conditions. Vaccination continues to be critical for all children, especially those at increased risk of influenza-related complications.
Estimating the Burden of 2009 Pandemic Influenza A (H1N1) in the United States (April 2009–April 2010)
Shrestha SS, Swerdlow DL, Borse RH, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S75-S82.doi: 10.1093/cid/ciq012.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S75.full
Abstract. To calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States, we extrapolated from the Centers for Disease Control and Prevention's Emerging Infections Program laboratory-confirmed hospitalizations across the entire United States, and then corrected for underreporting. From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3–89.3 million), 274 304 hospitalizations (195 086–402 719), and 12 469 deaths (8868–18 306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death 4 to 7 times and 8 to 12 times greater, respectively, than estimates of impact due to seasonal influenza covering the years 1976–2001. In our study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza. These results confirm the necessity of a concerted public health response to pH1N1.
Influenza-Like Illness in a Community Surrounding a School-Based Outbreak of 2009 Pandemic Influenza A (H1N1) Virus–Chicago, Illinois, 2009
Janusz KB, Cortes JE, Serdarevic F, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S94-S101.doi: 10.1093/cid/ciq025.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S94.full
Abstract. In April 2009, following the first school closure due to 2009 pandemic influenza A (H1N1) (pH1N1) in Chicago, Illinois, area hospitals were inundated with patients presenting with influenza-like illness (ILI). The extent of disease spread into the surrounding community was unclear. We performed a household survey to estimate the ILI attack rate among community residents and compared reported ILI with confirmed pH1N1 cases and ILI surveillance data (ie, hospital ILI visits, influenza testing, and school absenteeism). The estimated ILI attack rate was 4.6% (95% confidence interval, 2.8%-7.4%), with cases distributed throughout the 5-week study period. In contrast, 36 (84%) of 43 confirmed pH1N1 cases were identified the week of the school closure. Trends in surveillance data peaked during the same week and rapidly decreased to near baseline. Public awareness and health care practices impact standard ILI surveillance data. Community-based surveys are a valuable tool to help assess the burden of ILI in a community.
Transmission of 2009 Pandemic Influenza A (H1N1) at a Public University—Delaware, April–May 2009
Guh A, Reed C, Gould HL, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S131-S137.doi: 10.1093/cid/ciq029.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S131.full
Abstract. We investigated the first documented university outbreak of the 2009 pandemic influenza A(H1N1) to identify factors associated with disease transmission. An online student survey was administered to assess risk factors for influenza-like illness (ILI), defined as fever with cough or sore throat. Of 6049 survey respondents, 567 (9%) experienced ILI during 27 March to 9 May 2009. Studying with an ill contact (adjusted risk ratios [aRR], 1.29; 95% confidence intervals [CI], 1.01-1.65) and caring for an ill contact (aRR, 1.51; CI, 1.14-2.01) any time during 27 March to 9 May were predictors for ILI. Respondents reported that 680 (6%) of 11,411 housemates were ill; living with an ill housemate was a predictor for ILI (RR, 1.38; CI, 1.04-1.83). Close contact or prolonged exposures to ill persons were likely associated with experiencing ILI. Self-protective measures should be promoted in university populations to mitigate transmission.
Non-Pharmaceutical Interventions during an Outbreak of 2009 Pandemic Influenza A (H1N1) Virus Infection at a Large Public University, April–May 2009
Mitchell T, Dee DL, Phares CR, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S138-S145.doi: 10.1093/cid/ciq056.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S138.full
Abstract. Nonpharmaceutical interventions (NPIs), such as home isolation, social distancing, and infection control measures, are recommended by public health agencies as strategies to mitigate transmission during influenza pandemics. However, NPI implementation has rarely been studied in large populations. During an outbreak of 2009 Pandemic Influenza A (H1N1) virus infection at a large public university in April 2009, an online survey was conducted among students, faculty, and staff to assess knowledge of and adherence to university-recommended NPI. Although 3924 (65%) of 6049 student respondents and 1057 (74%) of 1401 faculty respondents reported increased use of self-protective NPI, such as hand washing, only 27 (6.4%) of 423 students and 5 (8.6%) of 58 faculty with acute respiratory infection (ARI) reported staying home while ill. Nearly one-half (46%) of student respondents, including 44.7% of those with ARI, attended social events. Results indicate a need for efforts to increase compliance with home isolation and social distancing measures.
Household Transmission of 2009 Pandemic Influenza A (H1N1) and Nonpharmaceutical Interventions among Households of High School Students in San Antonio, Texas
Loustalot F, Silk BJ, Gaither A, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S146-S153.doi: 10.1093/cid/ciq057.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S146.full
Abstract. San Antonio, Texas, was one of the first metropolitan areas where 2009 pandemic influenza A (H1N1) virus (pH1N1) was detected. Identification of laboratory-confirmed pH1N1 in 2 students led to a preemptive 8-day closure of their high school. We assessed transmission of pH1N1 and changes in adoption of nonpharmaceutical interventions (NPIs) within households of students attending the affected school. Household secondary attack rates were 3.7% overall and 9.1% among those 0–4 years of age. Widespread adoption of NPIs was reported among household members. Respondents who viewed pH1N1 as very serious were more likely to adopt certain NPIs than were respondents who viewed pH1N1 as not very serious. NPIs may complement influenza vaccine prevention programs or be the only line of defense when pandemic vaccine is unavailable. The 2009 pandemic provided a unique opportunity to study NPIs, and these real-world experiences provide much-needed data to inform pandemic response policy.
Investigating 2009 Pandemic Influenza A (H1N1) in US Schools: What Have We Learned?
Iuliano DA, Dawood FS, Silk BJ, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S161-S167.doi: 10.1093/cid/ciq032.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S161.full
Abstract. US investigations of school-based outbreaks of 2009 pandemic influenza A (H1N1) virus infection characterized influenza-like illness (ILI) attack rates, transmission risk factors, and adherence to nonpharmaceutical interventions. We summarize seven school-based investigations conducted during April–June 2009 to determine what questions might be answered by future investigations. Surveys were administered 5–28 days after identification of the outbreaks, and participation rates varied among households (39–86%) and individuals (24–49%). Compared with adults (4%–10%) and children aged <4 years (2%–7%), elementary through university students had higher ILI attack rates (4%–32%). Large gatherings or close contact with sick persons were identified as transmission risk factors. More participants reported adherence to hygiene measures, but fewer reported adherence to isolation measures. Challenges included low participation and delays in survey initiation that potentially introduced bias. Although school-based investigations can increase our understanding of epidemiology and prevention strategy effectiveness, investigators should decide which objectives are most feasible, given timing and design constraints.
A Model Survey for Assessing 2009 Pandemic Influenza A (H1N1) Virus Disease Burden in the Workplace
Gindler J, Grohskopf LA, Biggerstaff M, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S173-S176.doi: 10.1093/cid/ciq034.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S173.full
Abstract. Emergence of 2009 pandemic influenza A (H1N1) (pH1N1) virus in 2009 raised concern about the potential impact of widespread or severe disease on the nation's workforce. The Centers for Disease Control and Prevention recommended that employers develop flexible pandemic response plans. We used the Behavioral Risk Factor Surveillance System's influenza module as a model for a brief workplace survey to ascertain the influenza-like illness (ILI) burden on epidemiology staff in Centers for Disease Control and Prevention Emergency Operations Center. Fifty-seven (78%) of 73 recipients completed the survey. Ten (18%) met the ILI case definition. The 10 respondent ILI cases missed 24 total work days, although none sought medical care. Eleven (14%) of 77 household contacts also had ILI, but no ILI case was hospitalized. This survey enabled us to rapidly obtain information about our workforce ILI burden and evaluate the potential need for additional resources because of employee absence.
Transmission of Pandemic (H1N1) 2009 Influenza to Healthcare Personnel in the United States
Wise ME, De Perio M, Halpin J, et al. Clin Infect Dis. 14 December 2010;52 (suppl 1): S198-S204.doi: 10.1093/cid/ciq038.
Available at http://cid.oxfordjournals.org/content/52/suppl_1/S198.full
Abstract. After identification of pandemic 2009 influenza (pH1N1) in the United States, the Centers for Disease Control and Prevention (CDC) worked with state and local health officials to characterize infections among healthcare personnel (HCP). Detailed information, including likely routes of exposure, was reported for 70 HCP from 22 states. Thirty-five cases (50%) were classified as being infected in healthcare settings, 18 cases (26%) were considered to have been infected in community settings, and no definitive source was identified for 17 cases (24%). Of the 23 HCP infected by ill patients, only 20% reported using an N95 respirator or surgical mask during all encounters and more than half worked in outpatient clinics. In addition to community transmission, likely patient-to-HCP and HCP-to-HCP transmission were identified in healthcare settings, highlighting the need for comprehensive infection control strategies including administration of influenza vaccine, appropriate management of ill HCP, and adherence to infection control precautions.
Hospitalized Children with 2009 Pandemic Influenza A (H1N1): Comparison to Seasonal Influenza and Risk Factors for Admission to the ICU
Bagdure D, Curtis DJ, Dobyns E, et al. PLoS One. 15 December 2010;5(12): e15173. doi:10.1371/journal.pone.0015173.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015173
Background. Limited data are available describing the clinical presentation and risk factors for admission to the intensive care unit for children with 2009 H1N1 infection.
Methods. We conducted a retrospective chart review of all hospitalized children with 2009 influenza A (H1N1) and 2008–09 seasonal influenza at The Children's Hospital, Denver, Colorado.
Results. Of the 307 children identified with 2009 H1N1 infections, the median age was 6 years, 61% were male, and 66% had underlying medical conditions. Eighty children (26%) were admitted to the ICU. Thirty-two (40%) of the ICU patients required intubation and 17 (53%) of the intubated patients developed acute respiratory distress syndrome (ARDS). Four patients required extracorporeal membrane oxygenation. Eight (3%) of the hospitalized children died. Admission to the ICU was significantly associated with older age and underlying neurological condition. Compared to the 90 children admitted during the 2008–09 season, children admitted with 2009 H1N1 influenza were significantly older, had a shorter length of hospitalization, more use of antivirals, and a higher incidence of ARDS.
Conclusions. Compared to the 2008–09 season, hospitalized children with 2009 H1N1 influenza were much older and had more severe respiratory disease. Among children hospitalized with 2009 H1N1 influenza, risk factors for admission to the ICU included older age and having an underlying neurological condition. Children under the age of 2 hospitalized with 2009 H1N1 influenza were significantly less likely to require ICU care compared to older hospitalized children.
The effect of influenza vaccination on risk of acute myocardial infarction: Self-controlled case-series study
Gwini SM, Coupland CAC, Siriwardena AN. Vaccine. 18 December 2010. doi:10.1016/j.vaccine.2010.12.017.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-51RBWJJ-6&_user=10&_coverDate=12%2F18%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4b2a991b92c20e25bf39b3bb763c27d3&searchtype=a
Abstract. Acute myocardial infarction (AMI) peaks in winter months, partly linked to epidemic influenza. This implies that influenza vaccination may prevent some cases of AMI. This study investigated the association between influenza vaccination and AMI using the self-controlled case-series method. We identified 8180 cases of first AMI aged 40 years and over at time of diagnosis. The incidence of AMI was significantly reduced in the 60 days following vaccination (compared with the baseline period), ranging from a reduction of 32% (IRR 0.68; 95% CI 0.60–0.78) at 1–14 days after vaccination, to 18% (IRR 0.82; 95% CI 0.75–0.90) at 29–59 days after vaccination. Reductions in AMI incidence were more pronounced for early seasonal vaccinations before mid-November.
Serologic Status for Pandemic (H1N1) 2009 Virus, Taiwan
Huang D T-N, Shao P-L, Huang K-C, et al. Emerg Infect Dis. 20 December 2010;17(1) doi: 10.3201/eid1701.100014.
Available at http://www.cdc.gov/eid/content/17/1/76.htm#cit
Abstract. We studied preexisting immunity to pandemic (H1N1) 2009 virus in persons in Taiwan. A total of 18 (36%) of 50 elderly adults in Taiwan born before 1935 had protective antibodies against currently circulating pandemic (H1N1) 2009 virus. Seasonal influenza vaccines induced antibodies that did not protect against pandemic (H1N1) 2009 virus.
Pandemic H1N1 in Children Requiring Intensive Care in Australia and New Zealand During Winter 2009
Yung M, Slater A, Festa M, et al. Pediatrics. 20 December 2010. doi:10.1542/peds.2010-0801.
Available at http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-0801v1
Objective. To describe in detail the pediatric intensive care experience of influenza A, particularly pandemic H1N1-09, in Australia and New Zealand during the 2009 Southern Hemisphere winter and to compare the pediatric experience with that of adults.
Method. This was an inception-cohort study of all children who were admitted to intensive care with confirmed influenza A during winter 2009 at all general ICUs and PICUs in Australia and New Zealand.
Results. From June 1 through August 31, 2009, 107 children (20.0 per million [95% confidence interval: 16.1–23.8]) with influenza A, including 83 (15.5 per million [95% confidence interval: 12.1–18.9]) with H1N1-09 were admitted to ICUs. Fifty-two percent (39 of 75) of children with H1N1-09 had 1 or more comorbidity, most commonly neurologic (20%). Most (48 of 83 [58%]) presented with pneumonia. Thirteen of 83 (16%) had neurologic presentations. Eighty percent of the children with H1N1-09 required ventilation. Mortality was lower than in adults: 6 of 83 (7%) vs 114 of 668 (17%) (P = .02). The median length of stay for children with H1N1-09 was 5 days. Children with H1N1-09 occupied 773 bed-days (147 per million children) and 5.8% of specialist PICU beds. Presentation with septic shock or after cardiac arrest and the presence of 1 or more comorbidities were risk factors for severe disease.
Conclusions. H1N1-09 caused a substantial burden on pediatric intensive care services in Australia and New Zealand. Compared with adults, children more commonly had nonrespiratory presentations and required ventilation more often but had a lower mortality rate.
Influenza Pandemic Waves under Various Mitigation Strategies with 2009 H1N1 as a Case Study
Ghose S, Heffernan J. PLoS One. 20 December 2010;5(12): e14307. doi:10.1371/journal.pone.0014307.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0014307
Abstract. A significant feature of influenza pandemics is multiple waves of morbidity and mortality over a few months or years. The size of these successive waves depends on intervention strategies including antivirals and vaccination, as well as the effects of immunity gained from previous infection. However, the global vaccine manufacturing capacity is limited. Also, antiviral stockpiles are costly and thus, are limited to very few countries. The combined effect of antivirals and vaccination in successive waves of a pandemic has not been quantified. The effect of acquired immunity from vaccination and previous infection has also not been characterized. In times of a pandemic threat countries must consider the effects of a limited vaccine, limited antiviral use and the effects of prior immunity so as to adopt a pandemic strategy that will best aid the population. We developed a mathematical model describing the first and second waves of an influenza pandemic including drug therapy, vaccination and acquired immunity. The first wave model includes the use of antiviral drugs under different treatment profiles. In the second wave model the effects of antivirals, vaccination and immunity gained from the first wave are considered. The models are used to characterize the severity of infection in a population under different drug therapy and vaccination strategies, as well as school closure, so that public health policies regarding future influenza pandemics are better informed.
Spatio-Temporal Data Comparisons for Global Highly Pathogenic Avian Influenza (HPAI) H5N1 Outbreak
Zhang Z, Chen D, Chen Y, et al. PLoS One. 20 December 2010;5(12): e15314. doi:10.1371/journal.pone.0015314.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015314
Abstract. Highly pathogenic avian influenza subtype H5N1 is a zoonotic disease and control of the disease is one of the highest priority in global health. Disease surveillance systems are valuable data sources for various researches and management projects, but the data quality has not been paid much attention in previous studies. Based on data from two commonly used databases (Office International des Epizooties (OIE) and Food and Agriculture Organization of the United Nations (FAO)) of global HPAI H5N1 outbreaks during the period of 2003–2009, we examined and compared their patterns of temporal, spatial and spatio-temporal distributions for the first time. OIE and FAO data showed similar trends in temporal and spatial distributions if they were considered separately. However, more advanced approaches detected a significant difference in joint spatio-temporal distribution. Because of incompleteness for both OIE and FAO data, an integrated dataset would provide a more complete picture of global HPAI H5N1 outbreaks. We also displayed a mismatching profile of global HPAI H5N1 outbreaks and found that the degree of mismatching was related to the epidemic severity. The ideas and approaches used here to assess spatio-temporal data on the same disease from different sources are useful for other similar studies.
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
CDC updates guidance on rapid flu tests
The US Centers for Disease Control and Prevention (CDC) issued on 14 December 2010 guidance on the use of rapid flu diagnostic tests for the current flu season. Rapid tests can identify influenza A or B in 15 minutes or less but do not identify influenza A subtypes. Like previous versions of the guidance, the latest version says the rapid tests may be useful in clinical settings for deciding whether to prescribe antivirals, but because of the tests' limited sensitivity, negative results do not exclude flu in patients with flu-like illness. The guidance also says rapid tests can be useful for identifying flu as a cause of outbreaks in institutions such as nursing homes, hospitals, summer camps, and schools.
Additional information available at http://www.cdc.gov/flu/professionals/diagnosis/clinician_guidance_ridt.htm
Designing Climate Change Adaptation Initiatives
The UNDP has released "Designing Climate Change Adaptation Initiatives: A Toolkit for Practitioners". The Toolkit provides step-by-step guidance on key elements to be considered when developing and designing adaptation initiatives. It also differentiates between adaptation and traditional development initiatives, and outlines fundamental components of the design process, the approach to building stakeholder consensus, and key tools and methodologies.
Additional information available at http://www.uncclearn.org/undp_launches_toolkit_support_countries_designing_