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Vol. XIV No. 3 ~ EINet News Briefs ~ Feb 04, 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
- 2011 Cumulative number of human cases of avian influenza A/H5N1
- Global: WHO influenza update
- Global: Europe's influenza activity shows slow increase
- Russia: Influenza in Moscow triggers week-long school closure
- Egypt: WHO confirms H5N1 influenza in seven-year-old boy

2. Infectious Disease News
- Australia (Queensland): Leptospirosis alert
- Australia (Queensland): Melioidosis at Caboolture flood site
- Australia (Queensland): Measles outbreak fear hits Brisbane
- Australia (South Australia): Suffering from Ross River virus outbreak
- Indonesia: Nusa Penida Islands on rabies alert
- New Zealand: Measles warning issued by Auckland Regional Public Health Service
- Russia: Measles control in Krasnoyarsk
- Chile (Casablanca): Fatal victim Hantavirus infection
- Chile (Biobio): Death from Hantavirus infection in three-year-old child
- USA (New Mexico): DoH announces second Hantavirus case diagnosed in 2011

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

4. Articles
- Immunization Disparities by Hispanic Ethnicity and Language Preference
- Risk of Influenza-Like Illness in an Acute Health Care Setting During Community Influenza Epidemics in 2004-2005, 2005-2006, and 2006-2007
- Comparison of Pandemic (H1N1) 2009 and Seasonal Influenza Viral Loads, Singapore
- Immunogenicity and Cross-Reactivity of 2009–2010 Inactivated Seasonal Influenza Vaccine in US Adults and Elderly
- School Closures and Student Contact Patterns
- Nurses’ ability and willingness to work during pandemic flu
- Knowledge and Attitudes of Healthcare Workers in Chinese Intensive Care Units Regarding 2009 H1N1 Influenza Pandemic
- Pandemic (H1N1) 2009–associated Pneumonia in Children, Japan
- Comparison of Patients Hospitalized With Pandemic 2009 Influenza A (H1N1) Virus Infection During the First Two Pandemic Waves in Wisconsin
- Human Mobility Networks, Travel Restrictions, and the Global Spread of 2009 H1N1 Pandemic
- Role of social networks in shaping disease transmission during a community outbreak of 2009 H1N1 pandemic influenza
- Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis
- Highly Pathogenic Avian Influenza (H5N1): Pathways of Exposure at the Animal-Human Interface, a Systematic Review
- New Avian Influenza Virus (H5N1) in Wild Birds, Qinghai, China
- Pathogenesis of the 1918 Pandemic Influenza Virus
- Safety of Influenza A (H1N1) Vaccine in Postmarketing Surveillance in China

5. Notifications
- 29th Annual UC Davis Infectious Diseases Conference
- APEC Senior Officials Meeting I and Related Meetings
- Communicable Disease Control Conference


1. Influenza News

Global
2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Egypt / 3 (0)
Total / 3 (0)

***For data on human cases of avian influenza prior to 2011, go to:
http://depts.washington.edu/einet/humanh5n1.html

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 519 (306) (WHO 2/2/2011)
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2011_02_02/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/2010_12_09_h5n1_avian_influenza_timeline_updates.pdf

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Global: WHO influenza update
Influenza transmission in North America appears to be leveling off or decreasing according to several national influenza indicators, though not all regions have experienced a peak yet. Influenza activity in North America has been related primarily to influenza A (H3N2) virus with some co-circulation of influenza type B in the United States (U.S.). Influenza transmission in the United Kingdom (U.K.), predominantly related to influenza A (H1N1) 2009, is now decreasing. Influenza activity on the European continent is increasing, particularly in the west, and countries are increasingly reporting severe and fatal cases. Severe cases have been reported in association with all three influenza viruses, H1N1 (2009), influenza A (H3N2), and influenza type B, but H1N1 (2009) appears to be disproportionately over-represented among severe cases when compared to the distribution of viruses in the community. The large majority of the viruses characterized from North America and Europe continue to be of the same lineages as those found in the current seasonal trivalent vaccine. Transmission in Northern Africa and Northern Asia has peaked recently and is declining. In the tropics, several countries of southern Asia have seen increasing trends recently mainly due to H1N1 (2009). Other tropical areas of the world and the temperate countries of the Southern Hemisphere are currently reporting very little influenza circulation.
(WHO 1/28/2011)

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Global: Europe's influenza activity shows slow increase
Flu activity in the World Health Organization's (WHO's) European region is spreading from west to east and is slowly increasing, with several countries reporting that the 2009 H1N1 virus is mainly responsible for severe infections. Fifteen countries, such as Luxembourg, Ireland, and Norway, reported widespread activity, while seven reported regional spread, for the week ending 16 January 2011. In countries that report doctor's visits for flu-like illness, about half reported increases, with two reporting decreases. The highest rates were in children younger than 15. Countries in the central part of the region mainly reported low activity. Ireland reported that a surge in flu activity was having a severe impact on its healthcare capacity, and Estonia, Georgia, and Israel reported moderate impact.

The 2009 H1N1 virus was dominant in western and northern Europe, with influenza A and B co-circulating in eastern parts of the region, such as Russia. Influenza B was the dominant strain in a few countries, including Belarus, Norway, and the Ukraine. Luxembourg detected some co-infections with 2009 H1N1 and influenza B.

Elsewhere, hospital officials in Hanoi reported a new spike in 2009 H1N1 hospitalization, the first in the last six months in Vietnam's capital, reported on 22 January 2011. Public health officials in Ho Chi Minh City also reported a similar recent increase in flu activity. Local officials are warning the public to take flu precautions in advance of Tet (Lunar New Year) travel and celebrations.

In other flu developments, an Egyptian doctor recently died of an 2009 H1N1 infection. Egypt's health ministry said on 23 January 2011 that a 51-year-old male doctor from northern Cairo was treated with oseltamivir (Tamiflu), but not until five days after his symptoms first appeared. The ministry spokesman said the man had an underlying condition: chronic chest inflammation caused by heavy smoking.
(CIDRAP 1/24/2011)

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Asia
Russia: Influenza in Moscow triggers week-long school closure
Moscow has closed all of its elementary schools for a week to battle an influenza epidemic described as the worst since 1998, reported 30 January 2011. The closure was expected to affect close to 500,000 children, according to school officials. One official said half of the students in some classes were home with the flu but that the situation in Moscow was relatively favorable compared with some other regions in central Russia. Officials said close to 92,000 Muscovites were suffering from flu or other respiratory infections and that 52,000 of them were children, which was 42% higher than the average of previous years. Week-long school closures also were ordered in the Ural city of Chelyabinsk and in the northern Far East town of Yakutsk. The shutdown in Moscow was the first of its kind since 1998.
(CIDRAP 1/31/2011)

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Africa
Egypt: WHO confirms H5N1 influenza in seven-year-old boy
Egypt's Ministry of Health has confirmed H5N1 avian flu in a seven-year-old boy from Gharbia governorate, the World Health Organization (WHO) reported 2 February 2011. The boy experienced symptoms and was hospitalized on 20 January 2011. He is reported to be in stable condition, and officials say he was exposed to sick poultry. His case is Egypt's and the world's third H5N1 case in 2011, and the country's 122nd overall. Of those, 40 have been fatal.
(CIDRAP 2/2/2011)

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2. Infectious Disease News

Asia
Australia (Queensland): Leptospirosis alert
A total of four people who were in flood-ravaged Theodore, a village in central Queensland, in the past few weeks have been confirmed to have a severe bacterial infection.

Dr. Bruce Chater said there were four confirmed and one suspected case of leptospirosis. I haven't seen a case of leptospirosis in 20 years, said the doctor who has been servicing the community since 1981. Probably because it's been dry for 20 years, in this case, it was very severe. Dr. Chater said one person had been in Theodore just after the floods and had gone back to Brisbane and presented to health professionals in the state's capital. He said another person was transferred to Brisbane while two people were treated in Moura Hospital.

Dr. Chater said there were concerns for the patients and what people might get it. He said there were no more concerns in the community as the mud had now dried. Dr. Chater said people started presenting with symptoms the day after the community was allowed back into Theodore.

The infection is commonly transmitted to humans by allowing water that has been contaminated by animal urine to come in contact with unhealed breaks in the skin, the eyes, or with the mucous membranes.
(ProMED 1/21/2011)

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Australia (Queensland): Melioidosis at Caboolture flood site
A disease outbreak has forced Moreton Bay Regional Council to close flood clean up sites at Caboolture's Centenary Lakes. Two council staff have contracted melioidosis, an infectious disease caused by a bacterium called Burkholderia pseudomallei.

A council spokesman said it was working with relevant agencies to address and investigate the incident, and was contacting everyone who may have worked at the site since the recent floods. They are being urged to seek medical assistance if they exhibit symptoms such as fever, headache, loss of appetite, cough, chest pain, and general muscle soreness, the spokesman said. In line with the health alert issued by Queensland's Chief Health Officer, members of the public are urged to stay clear of areas such as beaches, rivers, creeks, and other waterways that were subject to increased inflows of debris and run-off due to the recent floods. The bacteria that cause melioidosis are found in contaminated water and soil and spread to humans and animals through direct contact with the contaminated source.

[ProMED note: Most of the reports of melioidosis from Australia originate in the Northern Territory, however, the disease is also endemic in Queensland, which is east of the Northern Territory. The disease usually occurs during the rainy season and may be accentuated by extreme flooding from rain and also from tsunamis as occurred in 2005 in Thailand.]
(ProMED 1/27/2011)

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Australia (Queensland): Measles outbreak fear hits Brisbane
Residents in Brisbane's north have been urged to ensure they are vaccinated against measles amid fears a man diagnosed 25 January 2011 could have unwittingly spread the highly contagious virus. Queensland's Chief Health Officer Dr. Jeannette Young said she was concerned the 21-year-old man visited the busy Westfield Chermside Shopping Centre on 19 January 2011, when he would have been infectious.

It is understood the man contracted the virus on a recent flight into Brisbane from overseas; three other passengers on the same flight who continued on to another location were infectious with measles at the time. Queensland Health is contacting all other passengers who disembarked in Brisbane and who were seated close to the infected people.

[ProMED note: The flight referred to would almost certainly have been Emirates flight EK434, which arrived in Auckland (New Zealand) from Brisbane on 11 January 2011 with three (subsequently four) passengers exhibiting symptoms of measles virus infection.]
(ProMED 1/26/2011)

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Australia (South Australia): Suffering from Ross River virus outbreak
A sudden spur in the cases of those infected with either of the Ross River virus (RRV) and Barmah Forest virus (BFV) in South Australia created panic among the general public and the government. The alarming rise in the infected cases is credited to the ascended levels of water in the River Murray. The stagnated water has given rise to many water-borne diseases, thereby promoting the breeding of mosquitoes. Stephen Christley, the chief public health officer of South Australia, confirmed for 350 cases of RRV and BFV. The figure was just 16 in this season of 2010.

Following this, Dr. Christley said that while most people will recover completely in a few weeks, some can have quite severe symptoms for many months. Anyone suffering from symptoms should contact their doctor for advice immediately. He publicly appealed people to take care of themselves and to look out for symptoms, which include joint pain, rash, fever, fatigue, or muscular pain. He also advised everyone to make sure that there is no standing water nearby, as it becomes a breeding haven for mosquitoes. He asked to discard the containers like pots, bottles, cans, and tires that are holding water.
(TopNews 2/1/2011)

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Indonesia: Nusa Penida Islands on rabies alert
The District government of Nusa Penida in the Klungkung regency of Bali has declared an extraordinary situation for rabies for the island group located a short distance from Bali's southeast shore. The district of Nusa Penida includes the islands of Nusa Gede, Nusa Ceningan, and Nusa Lembongan.

The extraordinary situation alert was issued after the recent death of two local residents from rabies. Prior to these deaths, officials and local resident assumed the islands had escaped the epidemic of rabies taking place on nearby Bali.

The head of the Bali Heath Office, Dr. Nyoman Sutedja, declared a rabies alert for Nusa Penida on 17 January 2011. He expressed concern for the 17 dog bite cases that have occurred in past months that went untreated in the mistaken assumption there were no infected dogs on the island.

Calling for a ban on the movement of dogs between the island and the outside world, Sutedja said hilly geography of the islands complicated efforts to control rabies. He also said that dogs carrying the virus may be sheltering in the caves found in the hills of the islands.

[ProMED note: It was reported previously on 10 January 2011 that two residents of the island of Nusa Penida had died in a Bali hospital as a result of suspected rabies virus infection. That diagnosis now appears to have been confirmed and also that infection had occurred as a result of dog bite on the island of Nusa Penida -- previously considered to be a rabies-free zone. Currently there are another 17 inhabitants of the island who received dog bites in the past few months and are potential rabies cases since they received no post-exposure prophylaxis in the mistaken belief that the island dogs were free of rabies.

Visitors to any part of Bali should be aware that there are no rabies-free zones on the main island and its off-shore islands, and that the problem of canine rabies in Bali is far from resolved.]
(ProMED 1/23/2011)

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New Zealand: Measles warning issued by Auckland Regional Public Health Service
A warning has been issued by the Auckland Regional Public Health Service after seven measles cases were diagnosed in young Aucklanders, including one at Waitakere Hospital's emergency care centre. The patients are aged from three to sixteen, four of whom were on a flight from Brisbane to Auckland on 11 January 2011. A family group caught the viral disease overseas. One Auckland child was a severe case and was hospitalized, while another child was taken to hospital but not admitted.
(ProMED 2/1/2011)

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Russia: Measles control in Krasnoyarsk
As of 1 February 2011, nine laboratory confirmed cases of measles have been recorded in Krasnoyarsk. The vice-mayor of the city summoned a meeting with the municipal public health authorities to discuss the situation. The mayor's office stated that a widespread epidemic had been avoided because 95% vaccine coverage of both children and the 18-35 year age group had been achieved. Coverage of the migrant population remains a problem, with immunization coverage reaching no more than 53% of the population.

Immunization of the 18-35 year old age group is expected to be completed by 31 January 2011. Currently public health workers are operating in the 14 biggest markets in the city in an attempt to increase vaccine uptake among in the immigrant population of the city. The vice-mayor reaffirmed that immunization is the only feasible means of preventing measles and that it has to be comprehensive to succeed.
(ProMED 2/1/2011)

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Americas
Chile (Casablanca): Fatal victim Hantavirus infection
Just on 18 January 2011, the death of a woman aged 41, from Los Maitenes sector of the town of Casablanca, from a Hantavirus infection was confirmed. The death occurred on 6 January 2011 at the Carlos van Buren Hospital in Valparaiso. This information was confirmed by the Secretariat of the Ministry of Health, being the first case of a Hantavirus infection in the community. The victim died of cardiovascular failure. This was confirmed by the Institute of Public Health (ISP), an entity that contacted the family of the deceased to launch prospective monitoring of their health status.

Moreover, the Casablanca municipality, in conjunction with the Health SEREMI (Regional Ministerial Secretariat), is undertaking various actions to detect, prevent, and control of hantavirus transmission in the affected rural area, in order to detect possible infections and to educate the population about measures to be taken.
(ProMED 1/22/2011)

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Chile (Biobio): Death from Hantavirus infection in three-year-old child
A child of three years six months became the second fatal victim of an infection with a Hantavirus so far in 2011. The Institute of Public Health confirmed that the child died on 15 January 2011 in the Nacimiento community in BioBio. Following the death of the child, family members must undergo follow-up for six weeks, during which tests will be carried out to determine if anyone was infected.

This case is added to that of a 33-year-old man who died in the Pinto community in Nube province, after working in a cabin that was used as a storage area.

Given these cases, the epidemiologist unit of the Health SEREMI, Cecilia Soto, called for the populace to adopt preventive measures, such as ventilation of places that have been closed up and to adequately dispose of trash. She stated that a Hantavirus infection begins as an influenza manifestation, and later the clinical picture becomes complicated to the point that death may result.
(ProMED 1/22/2011)

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USA (New Mexico): DoH announces second Hantavirus case diagnosed in 2011
The New Mexico Department of Health announced on 23 January 2011 that a 51-year-old woman from McKinley County is hospitalized in critical condition at UNM Hospital in Albuquerque with the state’s second diagnosed case of Hantavirus Pulmonary Syndrome in 2011. An environmental investigation will be conducted to determine where the woman may have been exposed to the virus.

Cases of Hantavirus in the winter are not as common as in spring and summer and are usually due to rodents seeking shelter and food in homes and other buildings due to the cold weather, said Dr. Paul Ettestad, the Department of Health’s public health veterinarian. Being aware of your surroundings so that you avoid disturbing areas of rodent infestation, rodent nests, and droppings is very important along with making sure your house is sealed up so that rodents cannot enter.

People can become infected and develop disease from Hantaviruses when they breathe in aerosolized virus particles that have been transmitted by infected rodents through urine, droppings or saliva. The deer mouse is the main reservoir for the strain of Hantavirus that occurs in New Mexico, Sin Nombre virus. The Department of Health urges health-care workers and the general public to familiarize themselves with the symptoms of Hantavirus.
(Big Medicine 1/23/2011)

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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

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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 new outbreak of dengue fever has been declared in the far north Queensland town of Innisfail. Queensland Health on 28 January 2011 declared an outbreak after receiving confirmation at least one locally acquired case of the mosquito-borne virus. Meanwhile, an outbreak of the virus in the Cairns suburbs of Parramatta Park and Westcourt has been declared over.
(ProMED 1/31/2011)


Isreal
Dozens of residents of the Eshkol region and Gaza perimeter have been recently bitten by sand flies and suffer from infection and wounds which leave ugly scars. The sores are locally known as the Rose of Jericho (leishmaniasis).

In Kibbutz Urim alone, 27 members have been infected. Eshkol residents are not alone. Even in the Jerusalem area, the number of bitten persons recently increased. Several children from Maale-Edomim have been hospitalized in Shaare Zedek Hospital in Jerusalem after severe lesions were discovered on them as a result of fly bites. At the same time, the phenomenon spread to the Beth-Shean Valley area (northeast Israel).

Israel has always been considered a country with a high incidence of cutaneous leishmaniasis, but in recent years, its spread has increased. Leishmania is big trouble, and control efforts are insufficient, says Professor Eli Schwartz, director of the travelers clinic and tropical disease specialist in the Sheba Medical Center. It is not fatal, but no doubt it is very disturbing and causes serious aesthetic problems. Vast areas throughout the country are infected, from north to south. In some places, the situation is really terrible. We see people bitten dozens of times, showing 30 and 40 lesions on the body.

The disease is transmitted by the bite of the female sand fly. The flies bite an infected animal, often the rock hyrax (but in several parts of Israel, other rodents), and transmit the disease to people they bite. The red ulcers will appear after the incubation time, several weeks after the bite. It is not life-threatening, but painful and unaesthetic.

Authorities, as it turns out, do not rush to eradicate the fly. For example, Eshkol residents who approached the Department of the Environment in the Regional Council were told that so far, fly eradication measures could not be applied since by law the authorities are committed to eradicating mosquitoes only.
(ProMED 1/30/2011)


Peru (Iquitos)
The epidemic of dengue virus-2 Asian/American has now been present for a month and a half since the confirmation of the first cases in the Peruvian Amazon region and has reached epidemic levels. Health services and hospitals continue to apply contingency measures in the face of increasing demand for health care by patients with serious signs who require hospitalization. Human and laboratory resources have reached critical levels, and as of 18 January 2011, three deaths have been confirmed, and another three are highly probable dengue deaths, but confirmation has not been possible even though they had clinical pictures compatible with dengue infections.

The two city hospitals in Iquitos have provided hospital beds in auditoriums and reorganized treatment facilities to meet the demand; an average of 80 beds are available in each hospital for dengue patients. Currently, an average of eight to fifteen dengue patients are hospitalized in each hospital, challenging their installed capacity.

On 18 January 2011, the epidemic took the life of a ten-year-old girl, who developed dengue shock syndrome on the fourth day of her illness, with pleural leakage, ascites, liver damage and probably myocarditis, which led to general organ failure.

The office of the Regional Health unit is developing control measures through a fumigation campaign in Iquitos city and for 19 January 2011 declared a non-work day for a massive campaign to collect trash that could provide breeding sites for Aedes aegypti vector mosquitoes in order to contain the epidemic. The rainy season of the year that is expected to begin in coming months is favoring the progression of the epidemic and making control measures difficult.
(ProMED 1/24/2011)


Peru (Amazonas)
The health minister Oscar Ugarte said on 27 January 2011 that the dengue outbreak that is showing up in the Peruvian forest and has caused ten deaths, had originated in Brazil and is a new variety of the virus that was not known previously in Peru. He noted that this new strain, which has a rapid worsening clinical evolution which produces the shock type without causing bleeding.

[ProMED note: Although it is not indicated where this outbreak occurred, ProMED reported a significant dengue outbreak January 2011 in Iquitos, in the Peruvian Amazon, caused by dengue virus-2 Asian/American , so one presumes that this is the dengue virus serotype to which the Minister refers.]
(ProMED 1/31/2011)


Philippines (Santiago City)
A dengue outbreak has been declared in Santiago City in Isabela province. A total of 19 cases have been recorded from 1-14 January 2011; one of the patients died due to dengue shock syndrome.
(ProMED 1/24/2011)

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CHOLERA, DIARRHEA, and DYSENTARY
Canada (Quebec)
The first case of cholera in Quebec has been confirmed after the outbreak in Haiti that has killed more than 4,000 people since October 2011, but officials were quick to add there was no chance of retransmission of the disease.

A woman suffering from the disease was admitted in early January 2011 to Ste. Justine Hospital because of severe diarrhea. Upon hearing that the woman had recently been in Haiti, the emergency room doctor suspected cholera and had her placed in isolation, as is standard with any patient with severe diarrhea. She was given antibiotics and re-hydrated and released after a few days in hospital.

The last recorded case of cholera in Quebec came in 2007.
(Leader-Post 2/2/2011)


USA (Massachusetts)
A second Massachusetts resident has been diagnosed with cholera, and four others are suspected of having the intestinal ailment, as reported 28 January 2011.

Like the man treated the week of 24 January at Massachusetts General Hospital for the disease, the other patients attended a lavish wedding at a resort in the Dominican Republic and fell ill upon returning home. All the patients are recovering, and there is no evidence the disease is spreading in Massachusetts, said Dr. Larry Madoff, director of the Division of Epidemiology and Immunization at the Massachusetts Department of Public Health.

That setting was a high-end resort in the Dominican Republic, where more than 400 guests celebrated a wedding on 22 January 2011. Dozens, including attendees from Venezuela, the USA, and elsewhere, became sick after returning home. The timing of their symptoms suggests they were infected while in the Dominican Republic.

The source of the outbreak is unknown. It has been reported that guests dined on lobster, and shellfish can harbor the germs. But if food is cooked thoroughly, the risk of infection should be mitigated. Cholera most often spreads through tainted water or sewage but can be conveyed by contaminated food. The resort issued a statement saying that while it deeply regrets the food poisoning/cholera cases that recently occurred during an exclusive wedding party in a private villa residence within our resort, the food, drinks, and ice were provided by an outside catering company hired by the party's hosts.
(ProMED 1/30/2011)

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4. Articles
Immunization Disparities by Hispanic Ethnicity and Language Preference
Haviland AM, Elliott MN, Hambarsoomian K, et al. Arch Intern Med. 24 January 2011;171(2):158-165. doi:10.1001/archinternmed.2010.499.
Available at http://archinte.ama-assn.org/cgi/content/abstract/171/2/158

Background. Seasonal influenza and pneumococcal immunization rates are substantially lower for older Hispanics than for non-Hispanic whites.

Methods. Beneficiary-reported past-year influenza and lifetime pneumococcal immunization for English- and Spanish-preferring Hispanic beneficiaries were compared with those for non-Hispanic whites in cross-sectional bilingual survey data using data from 244 618 randomly sampled community-dwelling respondents (age 65 years) with the 2008 Medicare Consumer Assessment of Healthcare Providers and Systems survey (a 62% response rate). Weighted logistic regression estimated immunization disparities with and without adjustment for health status, sociodemographic variables related to access, and location. Hierarchical models examined the role of specific geographic factors in immunization disparities.

Results. Pneumococcal immunization rates for Spanish- and English-speaking Hispanics were substantially lower than those for non-Hispanic whites (40% and 56% vs 74%; P < .001 for both comparisons). Influenza immunization rates for Spanish- and English-speaking Hispanics were also lower than for non-Hispanic whites (64% and 68% vs 76%; P < .001 for both comparisons). Health status–adjusted differences were similar; additional adjustment for sociodemographics reduced pneumococcal disparities by approximately one-third and influenza disparities by approximately half, but all disparities remained significant. Pneumococcal disparities were consistently smaller for patients in managed care plans. Influenza disparities were greater both in linguistically isolated areas and in "new destination" areas without long-standing Hispanic populations.

Conclusions. Hispanic seniors, especially when Spanish-preferring and in linguistically isolated "new destinations," such as the Southeast, continue to be immunized at markedly lower rates than non-Hispanic whites, even after adjustment for health and sociodemographics. Individual physicians and policymakers may be able to assist this vulnerable group by addressing cultural and linguistic barriers to immunization.

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Risk of Influenza-Like Illness in an Acute Health Care Setting During Community Influenza Epidemics in 2004-2005, 2005-2006, and 2006-2007
Vanhems P, Voirin N, Roche S, et al. Arch Intern Med. 24 January 2011;171(2):151-157. doi:10.1001/archinternmed.2010.500.
Available at http://archinte.ama-assn.org/cgi/content/abstract/171/2/151

Background. The person-to-person transmission of influenza-like illness (ILI) and influenza has been described mostly in long-term care units. Studies in acute hospital settings are rare and mostly retrospective.

Methods. We prospectively estimated the relative risk (RR) of hospital-acquired (HA) ILI during hospitalization according to in-hospital exposures to contagious individuals. Surveillance of ILI and laboratory-confirmed influenza was undertaken at Edouard Herriot Hospital (1100 beds) during 3 influenza seasons. A total of 21 519 patients and 2153 health care workers (HCWs) from 2004 to 2007 were included. The RR of HA-ILI in patients was calculated according to exposure to other contagious patients and HCWs.

Results. For patients exposed to at least 1 contagious HCW compared with those with no documented exposure in the hospital, the RR of HA-ILI was 5.48 (95% confidence interval [CI], 2.09-14.37); for patients exposed to at least 1 contagious patient, the RR was 17.96 (95% CI, 10.07-32.03); and for patients exposed to at least 1 contagious patient and 1 contagious HCW, the RR was 34.75 (95% CI, 17.70-68.25).

Conclusions. Hospitalized patients exposed to potentially infectious patients and HCWs with ILI inside the hospital are at greater risk for HA-ILI. Such results identify priorities regarding preventive measures for seasonal or pandemic influenza.

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Comparison of Pandemic (H1N1) 2009 and Seasonal Influenza Viral Loads, Singapore
Lee CK, Lee HK, Loh TP, et al. 2. Emerg Infect Dis. 28 January 2011;17(2) doi: 10.3201/eid1702.100282. Available at http://www.cdc.gov/eid/content/17/2/287.htm#cit Abstract. Mean viral loads for patients with pandemic (H1N1) 2009 were ≈1 log10 times lower than those for patients with seasonal influenza within the first week after symptom onset. Neither pandemic nor seasonal influenza viral loads correlated with clinical severity of illness. No correlation was found between viral loads and concurrent illness. Although clinical characteristics of pandemic (H1N1) 2009 have been well documented (1,2), fewer specific virologic comparisons with seasonal influenza have been studied in hospitalized patients (3). Studies of other influenza virus infections in humans suggest that host immune responses play a major role in determining clinical outcomes (4,5). We describe the initial viral loads for patients infected with pandemic (H1N1) 2009 and seasonal (H1 and H3) influenza viruses and their correlation with various aspects of signs and symptoms at admission to the National University Hospital (NUH) in Singapore.

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Immunogenicity and Cross-Reactivity of 2009–2010 Inactivated Seasonal Influenza Vaccine in US Adults and Elderly
Xie H, Jing X, Li X, et al. PLoS One. 31 January 2011;6(1): e16650. doi:10.1371/journal.pone.0016650.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0016650

Abstract. The campaign of 2009–2010 Northern Hemisphere seasonal vaccination was concurrent with the 2009 H1N1 pandemic. Using a hemagglutination inhibition (HAI) assay, we evaluated the immunogenicity and cross-reactivity of 2009–2010 inactivated trivalent influenza vaccine (TIV) in US adult and elderly populations. Vaccination of TIV resulted in a robust boost on the antibody response of all subjects to seasonal A/Brisbane/59/2007 (H1N1) and A/Uruguay/716/2007 (H3N2) with over 70% of recipients reaching a seroprotective titer of 40. B/Brisbane/60/2008 was the least immunogenic among the three seasonal vaccine strains with <30% of TIV recipients reaching a seroprotective titer of 40. TIV vaccination also induced a moderate boost on the pandemic specific antibody responses. Twenty-four percent of adults and 36% of elderly reached a seroprotective HAI titer of 40 or more against pandemic A/South Carolina/18/2009 (H1N1) after receiving TIV compared to 4% and 7% at the beginning of vaccination, respectively. In addition, 22% of adults and 34% of elderly showed an increase of 4-fold or more in A/South Carolina/18/2009 specific HAI titers after TIV vaccination. The pandemic specific cross-reactive antibodies strongly correlated with the post-vaccination HAI titers against the seasonal H3N2 vaccine strain in all subjects.

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School Closures and Student Contact Patterns
Jackson C, Mangtani P, Vynnycky, et al. Emerg Infect Dis. 21 Jan 2011. doi: 10.3201/eid1702.100458.
Available at http://www.cdc.gov/eid/content/17/2/245.htm#cit

Abstract. To determine how school closure for pandemic (H1N1) 2009 affected students' contact patterns, we conducted a retrospective questionnaire survey at a UK school 2 weeks after the school reopened. School closure was associated with a 65% reduction in the mean total number of contacts for each student. During pandemic (H1N1) 2009, several countries closed schools (1–6) to slow virus transmission. The effects of such school closures on student contact patterns have not been directly quantified. We report these effects for students from a UK secondary school.

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Nurses’ ability and willingness to work during pandemic flu
Dezzani Martin S. J of Nursing Management. 12 December 2010; 19(1):98-108. doi: 10.1111/j.1365-2834.2010.01190.x.
Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2834.2010.01190.x/abstract

Aim. The present study reports factors affecting nurses’ ability and willingness to work during pandemic flu (PF).

Background. Previous studies suggest some nurses may be unable or unwilling to work during PF.

Method. A questionnaire was mailed to nurses during October to December 2009, the second wave of the 2009 A/H1N1 flu pandemic.

Results. Most (90.1%) reported they would work. Willingness decreased primarily as personal protective equipment (PPE) dwindled, family or nurse were perceived to be at risk and when vaccine or antiviral medication was not provided to both nurse and family although many other factors also affected willingness to work. Ability decreased primarily when the nurse was sick, a loved one needed care at home or transportation problems existed although many other factors also affected ability to work.

Conclusion. Certain factors can decrease willingness and ability of nurses to work during a flu pandemic.

Implications for nursing management. Managers can anticipate factors that may decrease nurse’s ability and willingness to work during pandemic flu. Preparing for staffing during emergencies can retain the health care workforce when it is needed most.

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Knowledge and Attitudes of Healthcare Workers in Chinese Intensive Care Units Regarding 2009 H1N1 Influenza Pandemic
Ma X, He Z, Wang Y, et al. BMC Infect Dis. 25 January 2011;11:24. doi:10.1186/1471-2334-11-24.
Available at http://www.biomedcentral.com/1471-2334/11/24

Background. To describe the knowledge and attitudes of critical care clinicians during the 2009 H1N1 influenza pandemic.

Methods. A survey conducted in 21 intensive care units in 17 provinces in China.

Results. Out of 733 questionnaires distributed, 695 were completed. Three hundred and fifty-six respondents (51.2%) reported their experience of caring for H1N1 patients. Despite the fact that 88.5% of all respondents ultimately finished an H1N1 training program, only 41.9% admitted that they had the knowledge of 2009 H1N1 influenza. A total of 572 respondents (82.3%) expressed willingness to care for H1N1 patients. Independent variables associated with increasing likelihood to care for patients in the logistic regression analysis were physicians or nurses rather than other professionals (odds ratio 4.056 and 3.235, p = 0.002 and 0.007, respectively), knowledge training prior to patient care (odds ratio 1.531, p = 0.044), and the confidence to know how to protect themselves and their patients (odds ratio 2.109, p = 0.001).

Conclusion. Critical care clinicians reported poor knowledge of H1N1 influenza, even though most finished a relevant knowledge training program. Implementation of appropriate education program might improve compliance to infection control measures, and willingness to work in a pandemic.

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Pandemic (H1N1) 2009–associated Pneumonia in Children, Japan
Hasegawa M, Okada T, Sakata H, et al. Emerg Infect Dis. 28 January 2011;17(2). doi: 10.3201/eid1702.091904.
Available at http://www.cdc.gov/eid/content/17/2/279.htm#cit

Abstract. To describe clinical aspects of pandemic (H1N1) 2009 virus–associated pneumonia in children, we studied 80 such children, including 17 (21%) with complications, who were admitted to 5 hospitals in Japan during August–November 2009 after a mean of 2.9 symptomatic days. All enrolled patients recovered (median hospitalization 6 days). Timely access to hospitals may have contributed to favorable outcomes. We describe the clinical aspects of pandemic (H1N1) 2009 virus infection in children who developed spontaneous pneumomediastinum (1) or plastic bronchitis (2). In Mexico, 18 persons, including 5 children, had pandemic (H1N1) 2009–associated pneumonia (3). However, active surveillance to collect data on pneumonia cases among children infected with pandemic (H1N1) 2009 virus has not been conducted in Japan.

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Comparison of Patients Hospitalized With Pandemic 2009 Influenza A (H1N1) Virus Infection During the First Two Pandemic Waves in Wisconsin
Truelove SA, Chitnisa AS, Heffernan RT, et al. J of Infect Dis. 28 January 2011. doi: 10.1093/infdis/jiq117.
Available at http://jid.oxfordjournals.org/content/early/2011/01/28/infdis.jiq117.short

Background. Wisconsin was severely affected by pandemic waves of 2009 influenza A H1N1 infection during the period 15 April through 30 August 2009 (wave 1) and 31 August 2009 through 2 January 2010 (wave 2).

Methods. To evaluate differences in epidemiologic features and outcomes during these pandemic waves, we examined prospective surveillance data on Wisconsin residents who were hospitalized ≥24 h with or died of pandemic H1N1 infection.

Results. Rates of hospitalizations and deaths from pandemic H1N1 infection in Wisconsin increased 4- and 5-fold, respectively, from wave 1 to wave 2; outside Milwaukee, hospitalization and death rates increased 10- and 8-fold, respectively. Hospitalization rates were highest among racial and ethnic minorities and children during wave 1 and increased most during wave 2 among non-Hispanic whites and adults. Times to hospital admission and antiviral treatment improved between waves, but the overall hospital course remained similar, with no change in hospitalization duration, intensive care unit admission, requirement for mechanical ventilation, or mortality.

Conclusions. We report broader geographic spread and marked demographic differences during pandemic wave 2, compared with wave 1, although clinical outcomes were similar. Our findings emphasize the importance of using comprehensive surveillance data to detect changing characteristics and impacts during an influenza pandemic and of vigorously promoting influenza vaccination and other prevention efforts.

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Human Mobility Networks, Travel Restrictions, and the Global Spread of 2009 H1N1 Pandemic
Bajardi P, Poletto C, Ramasco JJ, et al. PLoS One. 31 January 2011;6(1): e16591. doi:10.1371/journal.pone.0016591.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0016591

Abstract. After the emergence of the H1N1 influenza in 2009, some countries responded with travel-related controls during the early stage of the outbreak in an attempt to contain or slow down its international spread. These controls along with self-imposed travel limitations contributed to a decline of about 40% in international air traffic to/from Mexico following the international alert. However, no containment was achieved by such restrictions and the virus was able to reach pandemic proportions in a short time. When gauging the value and efficacy of mobility and travel restrictions it is crucial to rely on epidemic models that integrate the wide range of features characterizing human mobility and the many options available to public health organizations for responding to a pandemic. Here we present a comprehensive computational and theoretical study of the role of travel restrictions in halting and delaying pandemics by using a model that explicitly integrates air travel and short-range mobility data with high-resolution demographic data across the world and that is validated by the accumulation of data from the 2009 H1N1 pandemic. We explore alternative scenarios for the 2009 H1N1 pandemic by assessing the potential impact of mobility restrictions that vary with respect to their magnitude and their position in the pandemic timeline. We provide a quantitative discussion of the delay obtained by different mobility restrictions and the likelihood of containing outbreaks of infectious diseases at their source, confirming the limited value and feasibility of international travel restrictions. These results are rationalized in the theoretical framework characterizing the invasion dynamics of the epidemics at the metapopulation level.

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Role of social networks in shaping disease transmission during a community outbreak of 2009 H1N1 pandemic influenza
Cauchemez S, Bhattarai A, Marchbanks TL, et al. PNAS. 31 January 2011. doi: 10.1073/pnas.1008895108.
Available at http://www.pnas.org/content/early/2011/01/28/1008895108.short

Abstract. Evaluating the impact of different social networks on the spread of respiratory diseases has been limited by a lack of detailed data on transmission outside the household setting as well as appropriate statistical methods. Here, from data collected during a H1N1 pandemic (pdm) influenza outbreak that started in an elementary school and spread in a semirural community in Pennsylvania, we quantify how transmission of influenza is affected by social networks. We set up a transmission model for which parameters are estimated from the data via Markov chain Monte Carlo sampling. Sitting next to a case or being the playmate of a case did not significantly increase the risk of infection; but the structuring of the school into classes and grades strongly affected spread. There was evidence that boys were more likely to transmit influenza to other boys than to girls (and vice versa), which mimicked the observed assortative mixing among playmates. We also investigated the presence of abnormally high transmission occurring on specific days of the outbreak. Late closure of the school (i.e., when 27% of students already had symptoms) had no significant impact on spread. School-aged individuals (6–18 y) facilitated the introduction and spread of influenza in households, but only about one in five cases aged >18 y was infected by a school-aged household member. This analysis shows the extent to which clearly defined social networks affect influenza transmission, revealing strong between-place interactions with back-and-forth waves of transmission between the school, the community, and the household.

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Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis
Klaiman T, Kraemer JD, Stoto MA. BMC Public Health. 1 February 2011; 11:73. doi:10.1186/1471-2458-11-73.

Background. School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making.

Methods. We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members.

Results. There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance.

Conclusions. The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly.

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Highly Pathogenic Avian Influenza (H5N1): Pathways of Exposure at the Animal-Human Interface, a Systematic Review
Van Kerkhove MD, Mumford E, Mounts AW, et al. PLoS One. 24 January 2011;6(1): e14582. doi:10.1371/journal.pone.0014582.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0014582

Background. The threat posed by highly pathogenic avian influenza A H5N1 viruses to humans remains significant, given the continued occurrence of sporadic human cases (499 human cases in 15 countries) with a high case fatality rate (approximately 60%), the endemicity in poultry populations in several countries, and the potential for reassortment with the newly emerging 2009 H1N1 pandemic strain. Therefore, we review risk factors for H5N1 infection in humans.

Methods and Findings. Several epidemiologic studies have evaluated the risk factors associated with increased risk of H5N1 infection among humans who were exposed to H5N1 viruses. Our review shows that most H5N1 cases are attributed to exposure to sick poultry. Most cases are sporadic, while occasional limited human-to-human transmission occurs. The most commonly identified factors associated with H5N1 virus infection included exposure through contact with infected blood or bodily fluids of infected poultry via food preparation practices; touching and caring for infected poultry; consuming uncooked poultry products; exposure to H5N1 via swimming or bathing in potentially virus laden ponds; and exposure to H5N1 at live bird markets.

Conclusions. Research has demonstrated that despite frequent and widespread contact with poultry, transmission of the H5N1 virus from poultry to humans is rare. Available research has identified several risk factors that may be associated with infection including close direct contact with poultry and transmission via the environment. However, several important data gaps remain that limit our understanding of the epidemiology of H5N1 in humans. Although infection in humans with H5N1 remains rare, human cases continue to be reported and H5N1 is now considered endemic among poultry in parts of Asia and in Egypt, providing opportunities for additional human infections and for the acquisition of virus mutations that may lead to more efficient spread among humans and other mammalian species. Collaboration between human and animal health sectors for surveillance, case investigation, virus sharing, and risk assessment is essential to monitor for potential changes in circulating H5N1 viruses and in the epidemiology of H5N1 in order to provide the best possible chance for effective mitigation of the impact of H5N1 in both poultry and humans.

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New Avian Influenza Virus (H5N1) in Wild Birds, Qinghai, China
Li Y, Liu L, Zhang Y, et al. Emerg Infect Dis. 28 January 2011; 17(2). DOI: 10.3201/eid1702.100732.
Available at http://www.cdc.gov/eid/content/17/2/265.htm#cit

Abstract. Highly pathogenic avian influenza virus (H5N1) (QH09) was isolated from dead wild birds (3 species) in Qinghai, China, during May–June 2009. Phylogenetic and antigenic analyses showed that QH09 was clearly distinguishable from classical clade 2.2 viruses and belonged to clade 2.3.2. In May 2005, highly pathogenic avian influenza (HPAI) virus (H5N1) caused a disease outbreak in wild birds in the Qinghai Lake region of the People's Republic of China (1). Subsequently, this virus (QH05, clade 2.2) disseminated from Asia to Europe and Africa, which has led to great concern and energetic debates about the role of migratory birds in influenza epidemics (1–5). In 2006, this virus was detected in migratory birds in Qinghai (6,7). In 2007, viruses similar to QH05 were isolated from surveyed anseriformes in Qinghai and showed only a short evolutionary distance from earlier viruses (8). Genetic diversity of avian influenza viruses (H5N1) was not detected in wild birds in Qinghai before 2008 (7,8). We report evidence that a second lineage of viruses, in addition to clade 2.2, has emerged in wild birds in Qinghai.

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Pathogenesis of the 1918 Pandemic Influenza Virus
Watanabe T, Kawaoka Y. PLoS. 27 January 2011;7(1): e1001218. doi:10.1371/journal.ppat.1001218.
Available at http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1001218

Background. At the height of World War I, the human population was assaulted by a powerful, but very small, foreign agent that rapidly appeared seemingly from nowhere. Ultimately identified as the “Spanish flu”, this agent wreaked havoc on anyone in its path. Prostrating vast numbers of victims worldwide with severe pneumonia, which often progressed to a fatal outcome, the “Spanish flu” caused an estimated 20–50 million deaths worldwide [1]. The resultant 1918 pandemic was one of the most formidable foes faced by humankind. In this brief review, we discuss some recent insights into the pathogenicity of its causative agent, the 1918 pandemic influenza virus.

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Safety of Influenza A (H1N1) Vaccine in Postmarketing Surveillance in China
Liang X-F, Li L, Liu DW, et al. New Eng J Med. 2 February 2011. (10.1056/NEJMoa1008553).
Available at http://www.nejm.org/doi/full/10.1056/NEJMoa1008553

Background. On September 21, 2009, China began administering vaccines, obtained from 10 different manufacturers, against 2009 pandemic influenza A (H1N1) virus infection in priority populations. We aimed to assess the safety of this vaccination program.

Methods. We designed a plan for passive surveillance for adverse events after immunization with the influenza A (H1N1) vaccine. Physicians or vaccination providers were required to report the numbers of vaccinees and all adverse events to their local Center for Disease Control and Prevention (CDC), which then reported the data to the Chinese CDC through the online National Immunization Information System's National Adverse Event Following Immunization Surveillance System. Data were collected through March 21, 2010, and were verified and analyzed by the Chinese CDC.

Results. A total of 89.6 million doses of vaccine were administered from September 21, 2009, through March 21, 2010, and 8067 vaccinees reported having an adverse event, for a rate of 90.0 per 1 million doses. The age-specific rates of adverse events ranged from 31.4 per 1 million doses among persons 60 years of age or older to 130.6 per 1 million doses among persons 9 years of age or younger, and the manufacturer-specific rates ranged from 4.6 to 185.4 per 1 million doses. A total of 6552 of the 8067 adverse events (81.2%; rate, 73.1 per 1 million doses) were verified as vaccine reactions; 1083 of the 8067 (13.4%; rate, 12.1 per 1 million doses) were rare and more serious (vs. common, minor events), most of which (1050) were allergic reactions. Eleven cases of the Guillain–Barré syndrome were reported, for a rate of 0.1 per 1 million doses, which is lower than the background rate in China.

Conclusions. No pattern of adverse events that would be of concern was observed after the administration of influenza A (H1N1) vaccine, nor was there evidence of an increased risk of the Guillain–Barré syndrome.

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5. Notifications
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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Communicable Disease Control Conference
Canberra, ACT, Australia, 4-6 April 2011
The Communicable Disease Control Conference aims to promote evidence-based discussions on the theme: Science and Public Health meeting the challenges of a new decade.
Additional information at http://www.phaa.net.au/2011CommunicableDiseaseConference.php

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 apecein@u.washington.edu