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Vol. XIV No. 1 ~ EINet News Briefs ~ Jan 07, 2011


*****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 activity up globally, in US, and notably in UK
- Global: Influenza activity increasing in France, Egypt
- Russia (Saratov): Outbreak of H1N1 influenza in gymnasium
- Egypt: WHO confirms two human H5N1 influenza cases
- Egypt: WHO confirms four H5N1 avian influenza cases

2. Infectious Disease News
- Australia: Flood clean-up brings infection risk
- Australia (New South Wales): Increased virulence of Clostridium difficile
- Hong Kong: Investigation of Streptococcus suis case
- Indonesia (Bali): Allots funds for anti-rabies vaccines
- Russia (Dagestan): Rabies cases from canine bite
- Canada (Ontario): Measles update

3. Updates
- INFLUENZA A/H1N1
- AVIAN INFLUENZA
- VECTOR-BORNE DISEASE

4. Articles
- Alert System to Detect Possible School-based Outbreaks of Influenza-like Illness
- The effectiveness of trivalent inactivated influenza vaccine in children over six consecutive influenza seasons
- Thermal Image Scanning for Influenza Border Screening: Results of an Airport Screening Study
- Pandemic (H1N1) 2009 Outbreak at Camp for Children with Hematologic and Oncologic Conditions
- Characteristics of Patients with Oseltamivir-Resistant Pandemic (H1N1) 2009, United States
- Perceptions of frontline staff regarding data collection methodologies used during the 2009 A H1N1 influenza immunization campaign in Canada
- Effectiveness of the pandemic influenza A/H1N1 2009 monovalent vaccine in Korea
- Antiviral Prescribing by Office-Based Physicians During the 2009 H1N1 Pandemic
- Acceptance of a vaccine against pandemic influenza A (H1N1) virus amongst healthcare workers in Beijing, China
- Sources, perceived usefulness and understanding of information disseminated to families who entered home quarantine during the H1N1 pandemic in Victoria, Australia: a cross-sectional study
- A Novel Risk Factor for a Novel Virus: Obesity and 2009 Pandemic Influenza A (H1N1)

5. Notifications
- International Meeting on Emerging Diseases and Surveillance (IMED 2011)
- 29th Annual UC Davis Infectious Diseases Conference
- APEC Senior Officials Meeting I and Related Meetings


1. Influenza News

Global
2010 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Cambodia / 1 (1)
China / 2 (1)
Egypt / 29 (13)
Indonesia / 9 (7)
Viet Nam 7 (2)
Total / 48 (24)

***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: 516 (306) (WHO 1/5/2011)
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2011_01_05/en/index.html

Avian influenza age distribution data from WHO/WPRO (last updated 11/19/10):
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 12/9/10):
http://www.who.int/csr/disease/avian_influenza/ai_timeline/en/index.html

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Global: Influenza activity up globally, in US, and notably in UK
The winter flu season is now officially under way in the Northern Hemisphere, the World Health Organization (WHO) reported 30 December 2010.

Meanwhile, US data also released 30 December 2010 show influenza activity again rising, and a third report says flu activity is increasing dramatically in the United Kingdom. The WHO update says cases of influenza-like illness (ILI) are now above baseline in parts of Canada and the United States and are primarily associated with influenza A (H3N2) and influenza B. The United Kingdom is seeing a surge in mild and severe cases in December 2010, according to the WHO, primarily associated with pandemic 2009 H1N1 and, to a lesser extent, influenza B. The illness pattern among those with H1N1 is similar to that seen during the pandemic in 2009, primarily affecting young adults, especially those with underlying conditions.

Elsewhere in Europe, the Middle East, and north Asia, ILI rates are low, but recent increases have been reported in some regions, the WHO report added.

Tropical regions are seeing little activity, but Sri Lanka has reported a marked increase of pandemic 2009 H1N1 cases, including 22 deaths.
(CIDRAP 12/30/2010)

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Global: Influenza activity increasing in France, Egypt
Influenza in France has reached epidemic levels, with 176,000 cases and two deaths winter season of 2010, reported 29 December 2010. Cases reached 280 per 100,000 population, well past the epidemic threshold of 174 per 100,000. Epidemiologic networks have identified three viral strains as causing illness, including 2009 pandemic H1N1. Officials are urging at-risk groups to get vaccinated. In Egypt, pandemic H1N1 has infected 1,172 people and killed 56 since 8 October 2010, Reuters reported. Overall, since the beginning of the pandemic in Egypt in June 2010, the virus has infected at least 16,373 people and killed at least 281.
(CIDRAP 12/29/2010)

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Asia
Russia (Saratov): Outbreak of H1N1 influenza in gymnasium
According to the Ministry of Health of the region, 12 students of a gymnasium in Saratov have been diagnosed with swine flu. Between 21 and 28 December 2010, four classes were closed because of a high incidence of viral respiratory infections. In 12 out of the 57 students tested, influenza A/(H1N1) virus infection was confirmed by laboratory diagnosis. The infections were of mild severity and all the students were kept under surveillance by local clinics.

In addition, two other schools were also closed for several days as a precautionary measure. The health care authorities of the city have reported that currently the influenza incidence in the general population is 2.9 percent below that observed in years prior to 2010. However the incidence in children of less than two years of age, and in the seven to fourteen years age group, is 6.5 percent and 2.4 percent, respectively, higher than previously observed.

The Ministry of Health has stated that 29 cases of swine flu have been recorded throughout the Saratov Oblast since the beginning of 2010, 17 of whom were registered at the beginning of 2010 and 12 in December 2010.
(ProMED 12/31/2010)

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Africa
Egypt: WHO confirms two human H5N1 influenza cases
The World Health Organization (WHO) confirmed on 29 December 2010 two cases of H5N1: in a 28-year-old woman from the Damanhour district of El Beheira governorate, and in an 11-year-old girl from Esna district of Luxor governorate. The 28-year-old woman became ill mid-December 2010 but has recovered. Her history included exposure in a live bird market. Earlier December 2010 reported on a 25-year-old woman infected with H5N1, which was presumably the case that the WHO confirmed on 30 December 2010. The 11-year-old girl developed symptoms 18 December 2010 and was hospitalized 19 December 2010 and required mechanical ventilation. She died on 23 December 2010. Of the 115 H5N1 cases confirmed as of 30 December 2010 in Egypt, 38 have been fatal. The global WHO-confirmed count now stands at 512 H5N1 cases and 304 deaths.
(CIDRAP 12/30/2010)

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Egypt: WHO confirms four H5N1 avian influenza cases
The World Health Organization (WHO) confirmed on 5 January 2011 four H5N1 avian influenza cases in Egypt, three of which had been previously reported, and added new details about the patients' medical care and exposure to poultry.

The patient whose H5N1 case had not been previously reported is a 56-year-old woman from Sharkia governorate who got sick on 22 December 2010 and was hospitalized 23 December 2010 and treated with oseltamivir (Tamiflu). She was discharged on 30 December 2010 in stable condition, the WHO reported. No information on her exposure to poultry is available, and a probe into the source of her infection is underway.

The WHO's confirmation of the previously reported patients includes:
1) A 25-year-old woman from Qena governorate, who became ill on 19 December 2010, was hospitalized on 27 December 2010 and died on 29 December 2010. An investigation found she had contact with poultry.
2) A 27-year-old man from Ismailia governorate got sick on 23 December 2010 and has been hospitalized since 28 December 2010. No information was available on his exposure to poultry, and an investigation into the source of his illness is ongoing.
3) A 40-year-old man from Dakahlia governorate, who came down with symptoms on 25 December 2010, was admitted to the hospital on 30 December 2010 and died on 2 January 2011. Authorities found that he had contact with poultry.

The newly confirmed cases raise Egypt's H5N1 total to 119 cases, including 40 deaths. Indonesia still leads the world in H5N1 cases and deaths, but Egypt has now tied with Vietnam for the second highest number of cases. Vietnam, however, has recorded 59 H5N1 deaths, compared to Egypt's 40.

The patient profile of Egypt's most recent cases is also somewhat different from the pattern of years before 2010. Women and children, two groups who have the most frequent contact with poultry in Egypt, have been hit hardest overall, but over 2010 several men were reported among the cases.
(CIDRAP 1/5/2011)

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2. Infectious Disease News

Asia
Australia: Flood clean-up brings infection risk
The Northern Territory Department of Health and Families is warning people to ensure they are protected from a potentially deadly soil disease when cleaning up after the recent floods. The soil-borne melioidosis bacteria are stirred up by wet dirt and can enter the body through cuts and sores or be inhaled.

Between October and December 2010, there has been a significant spike in diagnosed cases and three people have died. Another four people contracted the illness the week of 26 December 2010. People with pre-existing illnesses like diabetes and cancer are most at risk of serious illness or death.

The department says cleaning up after flooding increases the chance of exposure to the bacteria and is urging anyone working in muddy or pooled water to wear protective clothing and ensure any cuts are covered.
(ABC News 12/31/2010)

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Australia (New South Wales): Increased virulence of Clostridium difficile
New testing has found the first New South Wales cases of a super bug that has killed thousands of patients in European and North American hospitals. New South Wales Health says 21 patients tested positive to a virulent strain of Clostridium difficile, not detected in Australia until earlier in 2010 in Melbourne. Some of the symptoms include mild to severe diarrhea, fever, and stomach pains.

Professor Lyn Gilbert, chair of the New South Wales expert advisory group on health care associated infections, says New South Wales Health is now testing regularly for the bug. Some cases have been identified almost by chance in northern Sydney that have occurred over the last couple of years in several different hospitals in northern Sydney, she said. None of them have particularly severe disease, contrary to what happened in the northern hemisphere where it often was more severe than usual.
(ProMED 1/3/2011)

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Hong Kong: Investigation of Streptococcus suis case
On 28 December 2010, the Centre for Health Protection (CHP) of the Department of Health is investigating a case of confirmed infection by Streptococcus suis (a kind of bacterium isolated from pigs). The patient is a 56-year-old man who lives in Sha Tin. He developed fever, chills and confusion on 23 December 2010 and was admitted to Prince of Wales Hospital on 25 December 2010. He was diagnosed to have meningitis. He is now in stable condition. His blood and cerebrospinal fluid grew Streptococcus suis. A CHP spokesman said the patient had no recent travel history. His home contact did not have any symptoms.

This is the tenth case of Streptococcus suis infection reported in 2010; six cases were reported in 2009 and another six in 2008. The spokesman said Streptococcus suis infection may present as meningitis (inflammation of the membrane enclosing the brain), septicaemia (bloodstream infection), and less commonly endocarditis (inflammation of the inner lining of the heart chambers), arthritis, and bronchopneumonia (a kind of lung infection involving the bronchioles). Streptococcus suis infection can be treated with appropriate antibiotics.

To prevent the disease, members of the public are advised to always practice personal and environmental hygiene. They should avoid contact with pigs that are sick or dead from diseases and their excreta or body fluids. If contact with pigs or raw pork is necessary, one should use protective gloves; wash hands after handling pigs or raw pork; and clean and cover all wounds properly. Members of the public with suspected symptoms should consult their doctors as soon as possible and report their relevant exposure histories.
(ProMED 12/30/2010)

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Indonesia (Bali): Allots funds for anti-rabies vaccines
Anticipating an increase of rabies cases in Bali throughout 2011, the Bali Health Agency promised to allocate Rp 13 billion (USD 1.44 million) to procure anti-rabies vaccines for humans, an official said.

Despite the ongoing vaccination drive and efforts to stockpile anti-rabies vaccines, the infection still continues to claim more lives. Since the outbreak began in late 2008, continuing through the end of 2010, 107 people have died of the infection, with the number of fatalities increasing dramatically every year.

Rabies claimed four lives in Bali in 2008, and another 28 in 2009. In 2010, the number of victims soared to 75. The epidemic infected only a few villages in a regency in South Bali during its initial stages. Presently, the epidemic has spread to hundreds of villages located in all the island's eight regencies and one city.

Most victims failed to receive immediate and proper medical treatment after being bitten by infectious dogs, mainly due to difficult access from their remote villages to hospitals capable of providing the vaccine. The low level of public awareness on post-bite treatment has also led to many bite victims' unwillingness to seek proper medical treatment. Some hospitals in certain regencies reportedly have run out of vaccine stocks, but Suteja said the problem was due to the lack of coordination between the hospitals and designated rabies centers.

The Bali administration is set to allocate a total of Rp 48 billion to handle rabies cases, including procuring vaccines for dogs and culling street dogs. The central government and the provincial administration have campaigned that the resort island would be free from rabies by 2012. To help cope with the rising number of cases, the local administration is working together with non-government organizations to vaccinate at least 70 percent of the island's estimated 500,000 dogs.

Local Udayana University scientists have introduced the use of intradermal rabies vaccinations to more effectively combat the life-threatening disease. The vaccination is proven to be capable of giving a quicker and more protective antibody response as compared to the conventional intramuscular method.
(ProMED 1/6/2011)

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Russia (Dagestan): Rabies cases from canine bite
Fifteen human rabies cases were registered in Russia during 11 months of 2010. Similarly, there were also 11 human rabies cases in 2009. The main reasons for development of clinical signs of rabies in humans were refusal of immunization due to ignorance of its necessity, or incompletion of the vaccination schedule, or its disruption by irregular behavior during immunization (such as a consequence of alcoholism).

The sole human rabies case in Dagestan in 2010 was a visitor from Kalmykia who sought treatment at a hospital in Makhachkala after signs and symptoms of rabies virus infection were apparent. Another rabies case was registered in a resident of Dagestan who had been visiting the Yamalo-Nenets Autonomous Okrug. The epidemiological investigation of both cases identified bite by a domestic dog as the source of the infection. In both cases, the dogs died soon after the attacks. These circumstances are indicative of general lack of rabies risk awareness in the population of Dagestan.

Eighteen territories in Dagestan were designated rabies high-risk areas in 2010. This represents an increase of eight territories since 2009. A total of 5,998 people sought prophylactic rabies immunization in 2010 (221.2 per 100,000 population) compared with 7,207 people in 2009 (268.1 per 100,000 population).
(ProMED 12/31/2010)

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Americas
Canada (Ontario): Measles update
A total of six confirmed cases in Ottawa was reported as of 5 January 2011. The index case most likely acquired measles during travel. Subsequently, we have had five secondary cases reported and confirmed, that span across two generations of transmission. The secondary cases include close contacts and community transmission. The cases are within expected range in terms of demographics, clinical presentation and immunization status. Five were previously unvaccinated and one had a history compatible with one dose of MMR vaccine. There has not been local transmission of measles in Ottawa in 15 years, and the last case before this cluster was in 2002.
(ProMED 1/6/2011)

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

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

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

- Other useful sources
CIDRAP: Influenza A/H1N1 page: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html
ProMED: http://www.promedmail.org/
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
Big 10+2 Universities H1N1 Lessons Learned Webinar:
https://umconnect.umn.edu/p27358212/?launcher=false&fcsContent=true&pbMode=normal
CDC Open Letter to Americas urging influenza vaccination:
http://www.cdc.gov/flu/pdf/nivw/2010-2011open_letter_color.pdf
Results of CDC November 2010 Rapid Flu Survey: http://www.cdc.gov/flu/pdf/vaccination/rapidflusurvey.pdf

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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
Australia (North Queensland)
A recent dengue fever outbreak has spread to another two suburbs in Townsville in north Queensland. Cases have now been confirmed in the suburbs of Annandale and Vincent. In the last month, 28 people in the region have now contracted the disease. The Townsville City Council says all cases are linked and have warned residents to prepare for more.
(ProMED 12/27/2010)

Malaysia
Deaths from the mosquito-borne dengue virus rose 54 percent in Malaysia in 2010. A total of 134 people died from the disease in 2010, compared with 87 in 2009. The government also recorded a rise in the number of dengue cases with 45,901 reported in 2010 compared with 41,006 in 2009.
(ProMED 1/2/2011)

Mexico (Guerrero)
Acapulco has reported 1,198 dengue cases, 70 percent of which are classical dengue fever and 30 percent DHF. This is a very high proportion of DHF cases, suggesting that classical fever cases are under-reported.
(ProMED 12/27/2010)

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4. Articles
Alert System to Detect Possible School-based Outbreaks of Influenza-like Illness
Mann P, O’Connell E, Zhang G, et al. Emerg Infect Dis. 29 December 2010. doi: 10.3201/eid1702.100496.
Available at http://www.cdc.gov/eid/content/17/2/pdfs/10-0496.pdf

Background. To evaluate the usefulness of school absentee data in identifying outbreaks as part of syndromic surveillance, we examined data collected from public schools in Miami-Dade County, Florida, USA. An innovative automated alert system captured information about school-specific absenteeism to detect and provide real-time notification of possible outbreaks of influenza-like illness.

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The effectiveness of trivalent inactivated influenza vaccine in children over six consecutive influenza seasons
Katayose M, Hosoya M, Haneda, et al. Vaccine. 31 December 2010. doi:10.1016/j.vaccine.2010.12.049
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-51V45S2-4&_user=10&_coverDate=12%2F31%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=d181b20a92ff6e8831cf4386baf41fc7&searchtype=a

Objective. To estimate the effectiveness of two doses of trivalent inactivated influenza vaccine (TIV) over six consecutive influenza seasons in a small community in Japan.

Patients and Methods. A prospective, non-randomized, observational study of TIV effectiveness was performed involving children aged 6 months to 6 years accessing pediatric services in Soma and Shinchi, Japan. The total number of children under observation was 14,788. Each fall from 2002 to 2007 TIV was offered to all children with an average uptake of 52.9%. Influenza rapid diagnostic tests were performed to all children with respiratory symptoms and a temperature >38 °C during each surveillance period. The efficacy of two doses of TIV was estimated by the relative risk of influenza illness and influenza associated hospitalizations and effectiveness by reduction in all respiratory illness in vaccinated and unvaccinated children.

Results. Influenza A occurred each year resulting in approximately one in five children in the unvaccinated group having an influenza A related clinic visit. For influenza A, two doses of TIV showed yearly efficacies that ranged from 42% to 69% with the highest efficacy during the 2002/2003 influenza season when the vaccine strains were well matched with the circulating viruses. The overall efficacy of two doses of TIV against influenza A and B associated illness was 52% and 59%, respectively. TIV also reduced the rate of the influenza associated hospitalizations attributable to both influenza A and B.

Conclusions. Vaccination with two doses of TIV was consistently effective in preventing influenza-associated clinic visits and hospitalizations.

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Thermal Image Scanning for Influenza Border Screening: Results of an Airport Screening Study
Priest PC, Duncan AR, Jennings LC, et al. PLoS One. 5 January 2011;6(1): e14490. doi:10.1371/journal.pone.0014490.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0014490

Background. Infrared thermal image scanners (ITIS) appear an attractive option for the mass screening of travellers for influenza, but there are no published data on their performance in airports.

Methods. ITIS was used to measure cutaneous temperature in 1275 airline travellers who had agreed to tympanic temperature measurement and respiratory sampling. The prediction by ITIS of tympanic temperature (37.8°C and 37.5°C) and of influenza infection was assessed using Receiver Operating Characteristic (ROC) curves and estimated sensitivity, specificity and positive predictive value (PPV).

Findings. Using front of face ITIS for prediction of tympanic temperature ≥37.8°C, the area under the ROC curve was 0.86 (95%CI 0.75–0.97) and setting sensitivity at 86% gave specificity of 71%. The PPV in this population of travellers, of whom 0.5% were febrile using this definition, was 1.5%. We identified influenza virus infection in 30 travellers (3 Type A and 27 Type B). For ITIS prediction of influenza infection the area under the ROC curve was 0.66 (0.56–0.75), a sensitivity of 87% gave specificity of 39%, and PPV of 2.8%. None of the 30 influenza-positive travellers had tympanic temperature ≥37.8°C at screening (95%CI 0% to 12%); three had no influenza symptoms.

Conclusion. ITIS performed moderately well in detecting fever but in this study, during a seasonal epidemic of predominantly influenza type B, the proportion of influenza-infected travellers who were febrile was low and ITIS were not much better than chance at identifying travellers likely to be influenza-infected. Although febrile illness is more common in influenza A infections than influenza B infections, many influenza A infections are afebrile. Our findings therefore suggest that ITIS is unlikely to be effective for entry screening of travellers to detect influenza infection with the intention of preventing entry of the virus into a country.

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Pandemic (H1N1) 2009 Outbreak at Camp for Children with Hematologic and Oncologic Conditions
Morrison C, Maurtua-Neumann P, Myint MT, et al. Emerg Infect Dis. 23 December 2010. doi: 10.3201/eid1701.091499.
Available at http://www.cdc.gov/eid/content/17/1/87.htm#cit

Abstract. An outbreak of influenza A pandemic (H1N1) 2009 occurred among campers and staff at a summer camp attended by children with hematologic and oncologic conditions. The overall attack rate was 36% and was highest among children and adolescents (43%), persons with cancer (48%), and persons with sickle cell disease (82%).

Since it was first identified in April 2009 (1), the influenza A pandemic (H1N1) 2009 virus has sickened >1 million persons in the United States (www.cdc.gov/h1n1flu/surveillanceqa.htm). Because of the novelty of this virus, its transmissibility and severity are still under study.

We investigated an outbreak that occurred at a summer camp in northern rural Louisiana. Study approval was provided by the institutional review boards of Louisiana State University Health Sciences Center, Children's Hospital, and Tulane University Medical Center, New Orleans, Louisiana.

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Characteristics of Patients with Oseltamivir-Resistant Pandemic (H1N1) 2009, United States
Graitcer SB, Gubareva L, Kamimoto L, et al. Emerg Infect Dis. 29 December 2010. doi: 10.3201/eid1702.101724.
Available at http://www.cdc.gov/eid/content/17/2/pdfs/10-1724.pdf

Background. During April, 2009–June, 2010 the United States had enhanced surveillance for oseltamivir resistance among pandemic influenza A (H1N1) 2009 viruses. We describe characteristics of patients infected with oseltamivir-resistant and oseltamivir-susceptible pandemic (H1N1) 2009 virus.

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Perceptions of frontline staff regarding data collection methodologies used during the 2009 A H1N1 influenza immunization campaign in Canada
Foisy J, Quach S, Heidebrecht CL, et al. BMC Public Health. 30 December 2010;10:796. doi:10.1186/1471-2458-10-796.
Available at http://www.biomedcentral.com/1471-2458/10/796

Background. During the 2009 H1N1 immunization campaign, electronic and hybrid (comprising both electronic and paper components) systems were employed to collect client-level vaccination data in clinics across Canada. Because different systems were used across the country, the 2009 immunization campaign offered an opportunity to study the usability of the various data collection methods.

Methods. A convenience sample of clinic staff working in public health agencies and hospitals in 9 provinces/territories across Canada completed a questionnaire in which they indicated their level of agreement with seven statements regarding the usability of the data collection system employed at their vaccination clinic. Questions included overall ease of use, effectiveness of the method utilized, efficiency at completing tasks, comfort using the method, ability to recover from mistakes, ease of learning the method and overall satisfaction with the method. A 5-point Likert-type scale was used to measure responses.

Results. Most respondents (96%) were employed in sites run by public health. Respondents included 186 nurses and 114 administrative staff, among whom 90% and 47%, respectively, used a paper-based method for data collection. Approximately half the respondents had a year or less of experience with immunization-related tasks during seasonal influenza campaigns. Over 90% of all frontline staff found their data collection method easy to use, perceived it to be effective in helping them complete their tasks, felt quick and comfortable using the method, and found the method easy to learn, regardless of whether a hybrid or electronic system was used.

Conclusions. This study demonstrates that there may be a greater willingness of frontline immunization staff to adapt to new technologies than previously perceived by decision-makers. The public health community should recognize that usability may not be a barrier to implementing electronic methods for collecting individual-level immunization data.

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Effectiveness of the pandemic influenza A/H1N1 2009 monovalent vaccine in Korea
Song J-Y, Cheong HJ, Heo JY, et al. Vaccine. 1 January 2011. doi:10.1016/j.vaccine.2010.12.050.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-51VBJ9F-8&_user=10&_coverDate=01%2F01%2F2011&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=07728ee7b6f6830305dbb97761640195&searchtype=a

Abstract. The 2009 influenza pandemic was caused by a novel triple-reassortant influenza A/H1N1 virus that was further recombined with a Eurasian pig flu virus. Vaccination is a key countermeasure for disease; however, little data assessing vaccine effectiveness (VE) against the pandemic H1N1 virus are available. We conducted a matched case–control study to assess effectiveness of the 2009 influenza A/H1N1 monovalent vaccine against laboratory-confirmed, medically attended influenza patients. Subjects included in the study were ≥10 years of age and were treated at five university hospitals in the Republic of Korea (ROK) from December 2009 through March 2010. For subjects visiting outpatient clinics with influenza-like illness (ILI), real time reverse transcription polymerase chain reaction (rRT-PCR) was used to diagnose 2009 H1N1 influenza virus infection. Subjects with positive rRT-PCR were classified as cases, while those testing negative were controls. A valid vaccination corresponded to ≥14 days between receiving a dose of vaccine and symptom onset. Overall, 416 ILI subjects were analyzed, and 60 (14.4%) were vaccinated with the 2009 influenza A/H1N1 monovalent vaccine. The overall VE against pandemic 2009 A/H1N1 virus illness after adjustment for age group and presence of chronic medical conditions was 73.4% (95% confidence interval [CI] = 49.1–86.1%). Both vaccine formulations (unadjuvanted and MF-59 adjuvanted) showed a statistically significant VE. In conclusion, the 2009 influenza A/H1N1 monovalent vaccine was substantially protective against pandemic influenza in the ROK during the 2009–2010 season.

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Antiviral Prescribing by Office-Based Physicians During the 2009 H1N1 Pandemic
Hersh AL, Staffor RS. Annals of Internal Medicine. 3 January 2011; 154(1): 74-76.
Available at http://www.annals.org/content/154/1/74.extract

Background. Adherence to guidelines during public health emergencies is a national priority. Throughout the 2009 H1N1 influenza pandemic (1), the Centers for Disease Control and Prevention (CDC) issued guidelines recommending antiviral prescribing only to selected patients at high risk for complications, including patients younger than 2 years and patients 65 years or older, and not for prophylaxis (2). The extent to which antivirals were prescribed and how these practices differed from those in previous years is unknown.

Methods and Findings. We used data from the National Disease and Therapeutic Index (NDTI), a nationally representative survey of visits to ambulatory physicians produced by IMS Health, Plymouth Meeting, Pennsylvania. The survey includes approximately 4800 sampled physicians each calendar quarter who provide information about every clinical encounter during 2 consecutive workdays. Physicians are selected by random-stratified sampling by specialty and geographic region from the master lists of the American Medical Association and the American Osteopathic Association. Data for each visit include patient diagnoses based on codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and medications prescribed during these visits. The complex sampling frame allows extrapolation to national estimates for office visits and associated prescriptions. The NDTI has been used to examine patterns of …

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Acceptance of a vaccine against pandemic influenza A (H1N1) virus amongst healthcare workers in Beijing, China
Seale H, Kaur R, Wang Q, et al. Vaccine. 4 January 2011. doi:10.1016/j.vaccine.2010.12.077.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-51W08H7-D&_user=10&_coverDate=01%2F04%2F2011&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2ede30edd5519fe2297c2496a4ccfc8d&searchtype=a

Abstract. Due to the advent of the new influenza A (H1N1) strain in 2009, many countries introduced mass immunization programs. Healthcare workers (HCWs) were amongst the key groups targeted for the vaccine in these programs. However, experience with the seasonal influenza vaccine has shown that there are multiple barriers related to the attitudes and perceptions of the population which influence uptake. The aim of this study was to determine pandemic influenza A (H1N1) vaccination rate amongst a group of Chinese HCWs and the associated factors around acceptance.

A cross-sectional investigation of HCWs (doctors, nurses and technicians) from 19 hospitals in Beijing, China was conducted in January 2010. The main outcome measures were awareness, risk perception of H1N1, preventive measures and uptake of H1N1 vaccination during the pandemic. A total of 1657 HCWs completed the survey. A quarter of the participants reported receiving the pandemic influenza A (H1N1) vaccine. Occupation (being a doctor), receiving seasonal flu vaccine and believing in the effectiveness of the vaccine were all strongly associated with accepting the pandemic influenza A (H1N1) vaccine. Over a thousand participants (61%, 1008/1657) agreed that they were ‘concerned about the side effects of the swine flu vaccine’, while 758 (46%) were ‘concerned that the vaccine had not been tested adequately’.

While studies reported high rates of willingness to receive the vaccine, in reality these did not transpire. Aside from promoting seasonal flu vaccination, authorities need to start educational campaigns much earlier in a pandemic. Programs that are simultaneously launched with the introduction of the vaccine will not be as successful, as those which have built momentum alongside the pandemic.

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Sources, perceived usefulness and understanding of information disseminated to families who entered home quarantine during the H1N1 pandemic in Victoria, Australia: a cross-sectional study
Kavanagh AM, Bentley RJ, Mason KE, et al. BMC Infect Dis. 4 January 2011;11:2 doi:10.1186/1471-2334-11-2.
Available at http://www.biomedcentral.com/1471-2334/11/2

Background. Voluntary home quarantine of cases and close contacts was the main non-pharmaceutical intervention used to limit transmission of pandemic (H1N1) 2009 influenza (pH1N1) in the initial response to the outbreak of the disease in Australia. The effectiveness of voluntary quarantine logically depends on affected families having a clear understanding of what they are being asked to do. Information may come from many sources, including the media, health officials, family and friends, schools, and health professionals. We report the extent to which families who entered home quarantine received and used information on what they were supposed to do. Specifically, we outline their sources of information, the perceived usefulness of each source, and associations between understanding of recommendations and compliance.

Methods. Cross-sectional survey administered via the internet and computer-assisted telephone interview to families whose school children were recommended to go into home quarantine because they were diagnosed with H1N1 or were a close contact of a case. The sample included 314 of 1157 potentially eligible households (27% response rate) from 33 schools in metropolitan Melbourne. Adjusting for clustering within schools, we describe self-reported 'understanding of what they were meant to do during the quarantine period'; source of information (e.g. health department); and usefulness of information. Using logistic regression we examine whether compliance with quarantine recommendations was associated with understanding and the type of information source used.

Results. Ninety per cent understood what they were meant to do during the quarantine period, with levels of understanding higher in households with cases (98%, 95% CI 93%-99% vs 88%, 95% CI 84%-91%, p=0.006). Over 87% of parents received information about quarantine from the school, 63% from the health department and 44% from the media. 53% of households were fully compliant and there was increased compliance in households that reported that they understood what they were meant to do (Odds Ratio 2.27, 95% CI 1.35-3.80).

Conclusions. It is critical that public health officials work closely with other government departments and media to provide clear, consistent and simple information about what to do during quarantine as high levels of understanding will maximise compliance in the quarantined population.

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A Novel Risk Factor for a Novel Virus: Obesity and 2009 Pandemic Influenza A (H1N1)
Louie JK, Acosta M, Samuel MC, et al. Clinical Infect Dis. 4 January 2011. doi: 10.1093/cid/ciq152.
Available at http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq152.abstract

Background. Many critically ill patients with 2009 pandemic influenza A (H1N1) (2009 H1N1) infection were noted to be obese, but whether obesity, rather than its associated co-morbidities, is an independent risk factor for severe infection is unknown.

Methods. Using public health surveillance data, we analyzed demographic and clinical characteristics of California residents hospitalized with 2009 H1N1 infection to assess whether obesity (body mass index [BMI] ≥30) and extreme obesity (BMI ≥40) were an independent risk factor for death among case patients ≥ 20 years old.

Results. During the period 20 April–11 August 2009, 534 adult case patients with 2009 H1N1 infection for whom BMI information was available were observed. Two hundred twenty-eight patients (43%) were ≥50 years of age, and 378 (72%) had influenza-related high-risk conditions recognized by the Advisory Committee on Immunization Practices as risk factors for severe influenza. Two hundred and seventy-four (51%) had BMI ≥30, which is 2.2 times the prevalence of obesity among California adults (23%) and 1.5 times the prevalence among the general population of the United States (33%). Of the 92 case patients who died (17%), 56 (61%) had BMI ≥30 and 28 (30%) had BMI ≥40. In multivariate analysis, BMI ≥40 (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.4–5.9) and BMI ≥45 (OR, 4.2; 95% CI, 1.9–9.4), age ≥50 years (OR, 2.1; 95% CI, 1.2–3.7), miscellaneous immunosuppressive conditions (OR, 3.9; 95% CI, 1.6–9.5), and asthma (OR, 0.5; 95% CI, 0.3–0.9) were associated with death.

Conclusion. Half of Californians ≥20 years of age hospitalized with 2009 H1N1 infection were obese. Extreme obesity was associated with increased odds of death. Obese adults with 2009 H1N1 infection should be treated promptly and considered in prioritization of vaccine and antiviral medications during shortages.

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5. Notifications
International Meeting on Emerging Diseases and Surveillance (IMED 2011)
Vienna, Austria, 4-7 February 2011
The Program for Monitoring Emerging Diseases (ProMED), is pleased to invite you to the IMED 2011, following highly successful meetings in 2007 and 2009. Along with our co-sponsors, the Wildlife Conservation Society, the European Centre for Disease Prevention and Control, the World Organisation for Animal Health (OIE), the European Commission, and the European Society of Clinical Microbiology and Infectious Diseases, we are developing a conference that will bring together the public health community, scientists, health care workers and other leaders in the field of emerging infectious diseases. The meeting will embrace the “One Health” concept recognizing that, just as diseases reach across national boundaries, so do they transcend species barriers. We therefore welcome the full participation of both the human and animal health communities.
Additional information at http://imed.isid.org/

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29th Annual UC Davis Infectious Diseases Conference
Sacramento, CA, USA, 11-12 February 2011
Infectious disease is an area of medicine that is constantly changing. New pathogens are identified and newer therapeutic strategies are defined. This is an important opportunity to review and update participants on practical information.
Additional information at http://www.ucdmc.ucdavis.edu/cme/conferences/

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APEC Senior Officials Meeting I and Related Meetings
Washington DC, USA, 27 February to 12 March 2011

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 apecein@u.washington.edu