Login   

Vol. XIV No.6 ~ EINet News Briefs ~ Mar 18, 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: Influenza activity eases across much of Europe
- Global: H5N1 strikes farms in Japan, India
- Global: H5N1 avian influenza strikes poultry in Israel, Bangladesh, and South Korea
- Global: Pandemic review committee defends WHO response
- Australia: Monitoring of children for influenza-vaccine reactions
- Bangladesh: Second report of H5N1 avian influenza infection
- China: National Influenza Center designated as WHO collaborator
- Viet Nam: H5N1 avian influenza hits two provinces
- USA: CDC offers influenza brochure for prenatal care providers
- Egypt: Woman dies from H5N1 avian influenza infection
- USA: Influenza activity decreases

2. Infectious Disease News
- Australia: Measles outbreak in Victoria
- Russia: Contact with rabid fox and cattle
- South Korea: Twelve million doses of food-and-mouth disease vaccines
- Viet Nam: Foot-and-mouth disease spreads nationwide
- Canada: Botulism recall expands to all jam, jelly products
- Chile (Aisen): First confirmed case in 2011 of Hantavirus infection
- Peru (Amazonas): Rabies infection from exposure to rabid vampire bats
- USA (Ohio): Nosocomial Legionnaires’ disease
- USA (Oregon): Hantavirus death confirmed in central Oregon
- USA (Washington): Clark County investigates second child measles case in a month
- USA (Minnesota): Minneapolis baby treated for measles
- Australia: Measles scare at Gold Coast tourist spots
- Australia: Warning on measles outbreak in Blacktown local government area
- Chinese Taipei: Health authorities warn of possible measles outbreak

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

4. Articles
- Evaluating Research and Impact: A Bibliometric Analysis of Research by the NIH/NIAID HIV/AIDS Clinical Trials Networks
- 2008 outbreak of Salmonella Saintpaul infections associated with raw produce
- Atopy history and the genomics of wheezing after influenza vaccination in children 6–59 months of age
- Perceptions of and willingness to engage in public health precautions to prevent 2009 H1N1 influenza transmission
- Factors Affecting Intention to Receive and Self-Reported Receipt of 2009 Pandemic (H1N1) Vaccine in Hong Kong: A Longitudinal Study
- Wild Bird Migration across the Qinghai-Tibetan Plateau: A Transmission Route for Highly Pathogenic H5N1
- Assessing the Ecotoxicologic Hazards of a Pandemic Influenza Medical Response
- A Clinical Diagnostic Model for Predicting Influenza among Young Adult Military Personnel with Febrile Respiratory Illness in Singapore

5. Notifications
- Communicable Disease Control Conference
- ISID-Neglected Tropical Diseases Meeting
- Hot Topics 4 Video Symposium Highlights Video


1. Influenza News

Global
2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Cambodia / 3 (3)
Egypt / 11 (4)
Indonesia / 3 (3)
Total / 18 (10)

***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: 534 (316) (WHO 3/16/2011) http://www.who.int/csr/disease/avian_influenza/country/cases_table_2011_03_16/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 The full article on the Pandemic review committee’s response can be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/mar1011review-jw.html
(CIDRAP 3/10/2011)

^top

Global: Influenza activity eases across much of Europe
The World Health Organization (WHO) said 11 March 2011 that flu activity in its European region is decreasing in 22 countries, with Armenia, Iceland, and Ukraine reporting increases. Georgia is the only country to report high-intensity flu activity, down from five countries reporting that level the previous week. Georgia also reported that flu was severely affecting its healthcare system. Hospitalizations for severe flu infections are high in Ukraine, Romania, and Russia. The 2009 H1N1 virus and influenza B are co-circulating in northern and Western Europe, with H1N1 dominating in central and eastern areas
(CIDRAP 3/11/2011)

^top

Global: H5N1 strikes farms in Japan, India
Japan, which is in the midst of earthquake and nuclear plant emergency responses, recently reported more H5N1 avian influenza outbreaks at poultry farms. Officials in Chiba prefecture said the virus was confirmed at a poultry producer in Chiba city after a few birds were found dead on 12 and 13 March 2011. The remaining 35,000 birds were culled, and authorities have banned the movement of poultry in a 10-km radius around the farm. Japan has battled H5N1 in poultry and wild birds over the February and March 2011, and this is the first outbreak to strike Chiba, Japan's second largest poultry-producing area. Meanwhile, in a 11 March 2011 report to the World Organization for Animal Health (OIE), Japan reported three more H5N1 outbreaks on commercial poultry farms in three other prefectures: Mie, Nara, and Miyazaki. The outbreaks started between 26 February 2011 and 3 March 2011, killing 119 birds, with 372,881 more culled to stop the virus. Elsewhere, H5N1 struck a poultry-breeding farm in Ghandigam, India according to a 14 March 2011 report. The virus killed 380 of the farm's 4,000 birds, and the remaining poultry were culled. Ghandigam is in Tripura state in northeastern India.
(CIDRAP 3/15/2011)

^top

Global: H5N1 avian influenza strikes poultry in Israel, Bangladesh, and South Korea
Israel's agriculture ministry said 6 March 2011 that the H5N1 virus struck a turkey farm at religious settlement in the West Bank area, according to a report to the World Organization for Animal Health (OIE). The virus killed 200 and sickened 800 more of the farm's 13,000-bird flock of 14-week-old turkeys. The remaining birds will be culled, along with two other flocks at the settlement that consist of six-week-old and four-day-old turkeys. The source of the virus is under investigation. The latest H5N1 outbreak is Israel's first in more than a year.

In Bangladesh, livestock officials on 6 March 2011 reported 29 more H5N1 outbreaks at commercial poultry farms. The latest update covers outbreaks that occurred between 14-28 February 2011 at five of the country's seven divisions: Barisal, Chittagong, Dhaka, Khulna, and Rajshahi. The virus killed 12,573 birds, and authorities destroyed 70,139 more to contain the spread of the disease.

Elsewhere, South Korea reported on 8 March 2011 another outbreak, this time at an egg farm south of Seoul in Gyeonggi province. The country's National Veterinary Research and Quarantine Service said it was South Korea's 50th H5N1 confirmation in the latest round of outbreaks that began in late December 2010.
(CIDRAP 3/8/2011)

^top

Global: Pandemic review committee defends WHO response
An external committee reviewing the World Health Organization's (WHO's) performance during the H1N1 pandemic released a preview of its findings on 10 March 2011, which defends the WHO against criticism that it overstated the pandemic threat and recommends that it take several steps to improve future response.

The full article on the Pandemic review committee’s response can be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/mar1011review-jw.html
(CIDRAP 3/10/2011)

^top


Asia
Australia: Monitoring of children for influenza-vaccine reactions
A group of 600 children in Australia will receive special monitoring for adverse reactions to the 2011 influenza vaccine, in the wake of a rash of adverse events from 2010, a health official announced 15 March 2011. Australia's national immunization program, which provides free flu shots for everyone older than six months, began 15 March 2011. Dozens of children in Australia had serious reactions to the Fluvax vaccine made by CSL Ltd. In 2010 two other vaccines will be used in small children for 2011. Paul Armstrong, Western Australia's director of communicable disease control, said authorities will closely monitor a sample group of 600 children in 2011 by interviewing their parents. In 2010, the rate of fever and convulsions in Australian children under five who received Fluvax was about nine per 1,000 vaccinated, versus a normal rate of less than one in 1,000. CSL stated it has been unable to find an explanation for the increase. Because of the problem, the company has not sought approval for use of Fluvax in children under age five for the 2011 Southern Hemisphere flu season. The company also noted that fever and related symptoms were reported in some five- to eight-year-olds who received Fluvax in 2010, and as a result, the vaccine is not recommended for that age-group unless there is no alternative. CSL said it is collaborating with pediatric research centers in Australia in 2011 to monitor flu vaccine use in 600 children ages five to 18.
(CIDRAP 3/15/2011)

^top

Bangladesh: Second report of H5N1 avian influenza infection
Health officials in Bangladesh have confirmed another H5N1 avian influenza infection, the second one in a week. The new case is in a two-year-old boy who appeared at a surveillance site in Kamalapur with mild symptoms that included a fever and cough. Tests on the boy's respiratory and serum samples were conducted by the country's Institute of Epidemiology Disease Control and Research (IEDCR). Dr Mahmudur Rahman, director of the IEDCR, stated that the strain (clade 2.2) of the H5N1 virus that circulates in Bangladesh is less virulent than other strains.

The boy's illness was detected during surveillance related to the investigation of another recently reported case, in a 13-month-old girl whose infection was confirmed 16 March 2011 by the World Health Organization (WHO). However, Rahman said the boy is not related to the girl.

The WHO said on 16 March 2011 that Bangladesh's health ministry has confirmed a 16-month-old girl's infection with the H5N1 influenza. Her illness was reported by the media on 14 March 2011. The WHO said the girl's infection was detected at an IEDCR surveillance center in Kamalapur in Dhaka state. She was brought to the center on 8 March 2011with cough and fever and has since recovered. An investigation into the source of her illness is being conducted by Bangladeshi and WHO officials.

Her illness, plus the boy's infection, raise Bangladesh's H5N1 case total to three, none of which have been fatal. The other infection occurred in 2008, in a 16-month-old boy. If the WHO confirms the 16 March 2011 reported case, the global H5N1 case count would rise to 535, including 316 deaths.
(CIDRAP 3/16/2011)

^top

China: National Influenza Center designated as WHO collaborator
China's National Influenza Center has been designated as a World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza, making China the first developing country to host such a center. The center, part of the Chinese Center for Disease Control and Prevention, joins the WHO's collaborating influenza centers in Australia, Japan, the United Kingdom, and the United States. Dr. Shin Young-soo, the WHO regional director for the Western Pacific, stated that the National Influenza Center designation reflects the country's exceptional contribution to the global fight against influenza. He spoke in Beijing on 14 March 2011 at a ceremony marking the designation. Shu Yuelong, who heads the center, said it, like the other collaborating centers, will train medical personnel from other countries and issue timely warnings on flu outbreaks. He also said the designation will benefit both China and the rest of the world. Yuelong stated that unlike before, China can now get firsthand information from other collaborating centers on global influenza surveillance and studies, which will help them to better, shape the responses to the disease. This will also help the homegrown flu-vaccine industry tap the global market.
(CIDRAP 3/15/2011)

^top

Viet Nam: H5N1 avian influenza hits two provinces
Vietnam's agriculture ministry on 8 March 2011 reported two H5N1 avian influenza outbreaks, one at farm in Ha Nam province and the other at a village in Quang Ninh province, according to a notice from the World Organization for Animal Health (OIE). Both are in northern Vietnam. In the first outbreak, which began on 27 February 201, the virus killed 74 of the farm's 90 birds. The remaining ones were destroyed. In the village in Quang Ninh, the virus killed 1,200 of 2,000 susceptible birds starting on 12 February 2011, and 800 more were culled to control the spread of the virus. Outbreak investigations suggested that the source of the virus was likely the introduction of new live animals, illegal animal movement, or fomites.
(CIDRAP 3/8/2011)

^top


Americas
USA: CDC offers influenza brochure for prenatal care providers
The Centers for Disease Control and Prevention (CDC) has released a 15-page brochure to help prenatal care providers implement the agency's recently updated guidance on responding to flu and flu risks in pregnant women and labor and delivery settings. The "toolkit" brochure covers clinical presentation, prevention, treatment and prophylaxis, infection control, and intrapartum and newborn considerations, and it also offers information for patients. In the updated guidance, released 7 March 2011, the CDC no longer urges women with suspected or confirmed flu to wear a mask during labor, but the agency still recommends that facilities consider separating sick mothers from their babies.
(CIDRAP 3/11/2011)

^top


Africa
Egypt: Woman dies from H5N1 avian influenza infection
Egypt's health ministry recently announced that a 38-year-old woman from Ismalia governorate died from an H5N1 avian influenza infection, the World Health Organization (WHO) reported 15 March 2011. After getting sick on 1 March 2011, she was hospitalized on 7 March 2011, listed in critical condition, and placed on a ventilator. She died on 11 March 2011. An investigation found she had been exposed to sick poultry. The WHO said the woman's illness and death raise Egypt's H5N1 total to 130 cases, including 44 fatalities. So far this year Egypt has reported 10 H5N1 infections and 3 deaths. The latest Egyptian case raises the world's H5N1 count to 533 cases.
(CIDRAP 3/15/2011)

^top

USA: Influenza activity decreases
After several weeks of rising or strong flu activity, levels dropped on 4 March 2011, with most indicators showing declines, the US Centers for Disease Control and Prevention (CDC) said on 11 March 2011.

The number of states reporting widespread flu activity dropped from 44 to 39 on 4 March 2011, and nine reported regional activity. Some of the states reporting regional spread now are southeastern states that reported the nation's earliest widespread activity for 2011.

The percentage of doctor's visits for flu-like illness fell to 3.1% 4 March 2011, and though it is still above the 2.5% baseline, it was lower than the 4% the CDC reported 25 February 2011. In two of the CDC's ten regions doctor's visits for flu-like illness fell below baseline. For February 2011, all of them had been above that level.

Nationally, the proportion of respiratory specimens that tested positive for influenza was 24.7% on 4 March 2011, down from 27.9% 25 February 2011. All three influenza strains are circulating. About a fourth of the isolates were influenza B. Among the subtyped influenza A strains, H3N2 had a small edge over the 2009 H1N1 virus.

The only flu indicator that rose 4 March 2011 was the percentage of deaths from pneumonia and influenza, which jumped from 8% to 8.5%, putting it above the epidemic threshold (8.0%) again, the CDC said. In the past the CDC has said that deaths from flu and pneumonia tend to lag other flu measures.

The CDC received five reports of pediatric flu deaths 4 March 2011, raising the season's total to 60. Three were linked to influenza B, and three were associated with unsubtyped influenza A viruses. The toll of pediatric flu deaths was 14, on 25 February 2011.
(CIDRAP 3/11/2011)

^top


2. Infectious Disease News

Asia
Australia: Measles outbreak in Victoria
The Communicable Disease Prevention and Control Unit of the Victorian Government Department of Health is continuing to investigate the recent increase in imported cases of measles to Victoria. As of 1 March 2011, a total of 16 confirmed cases had been notified to the department. There were three cases aged less than 12 months, three aged between five and 16 years, six aged from 20 to 37 years, and the remainder were aged 45 to 66 years. Thirteen cases were reported to be not vaccinated and three cases were of unknown vaccination status.

Epidemiological investigations undertaken by the department and genotyping by the Victorian Infectious Diseases Reference Laboratory established the presence of at least four distinct genotype clusters. An additional five cases are awaiting genotyping, of which three are suspected to have been acquired overseas and two in Victoria, although no epidemiological link between these two latter cases and other cases has been established as of 1 March 2011. The index case in each of the four distinct genotype clusters (which includes two clusters of genotype D4, genotype D8 and genotype D9) acquired their infection overseas (South Asia, South East Asia, and the UK). Only one of the index cases so far has resulted in further cases at this stage. This particular cluster has seen second and third generations of cases. Situations in which transmission has occurred include household contacts, health facilities, and a supermarket. Most notable in this cluster are the two cases aged 60 and 66 years (who are siblings). These cases fall outside of the defined “population at risk” for measles (i.e., those born during or after 1966 when the vaccination became available in Australia). These two cases were found to have spent their childhood in a relatively remote rural region of Victoria, and presumably had never been exposed to the measles virus before now.

Six of the nine index cases (including those not linked to further cases) have been identified as unvaccinated (vaccination status for the remaining three cases was unknown). High immunization coverage in Victoria – 93% for one dose by two years of age, and 91% for two doses by five years of age appears to have assisted in halting further transmission from the other index cases.
(ProMED 3/8/2011)

^top

Russia: Contact with rabid fox and cattle
Six residents of the village of Mihaylovka, where there has been an outbreak of rabies in cattle, have been hospitalized on suspicion of exposure to rabies virus infection. According to Sergei Hanhareyev, Chief of the Russian Epidemiological Surveillance Centre in Buryatiya, these six people had contact with rabid cattle and with a rabid fox that probably was the source of infection of the cattle.

Ten people in total were in contact with infected animals; none of them developed any symptoms; however, doctors decided to vaccinate six of the ten and keep the other four under observation.

According to preliminary information, the cattle became infected as a result of contact with a rabid fox that was subsequently killed. As a result, three of the cows developed signs of rabies. These animals were euthanized after rabies virus infection was confirmed by laboratory tests carried out at the Irkusk Veterinary Laboratory. Anti-epidemic measures are in progress. 1,200 people live in Mihaylovka village, and the animal population comprises 2,700 cattle, 500 sheep and goats, 400 horses, and 1,300 domestic birds.
(ProMED 3/6/2011)

^top

South Korea: Twelve million doses of food-and-mouth disease vaccines
Intervet/Schering-Plough Animal Health announces on 4 March 2011 that it has shipped 12 million doses of foot-and-mouth disease (FMD) vaccine to South Korea to assist in the country's efforts to halt the ongoing FMD outbreak.

Since the FMD outbreak was reported by the South Korean government in November 2010, more than three million pigs, cattle, goats and deer have been culled. Late December 2010 the South Korean Ministry for Food, Agriculture, Forestry and Fisheries decided to start vaccinating all 13 million livestock in the country after initial measures were not effective in controlling the outbreak.

It is anticipated that the ongoing large scale vaccination campaign will soon show result in control of the outbreak in concert with the other measures applied.
(ProMED 3/5/2011)

^top

Viet Nam: Foot-and-mouth disease spreads nationwide
As of 12 March 2011, 26 provinces and cities across the country have declared an outbreak of foot-and-mouth disease (FMD).

Functional agencies in these localities are facing difficulties in combating the disease because they do not have enough vaccine against the deadly virus.

Nearly 500 cattle have been infected by FMD in the central province of Quang Nam. The epidemic has hit eight out of 18 districts in the province and is likely to spread more widely. The provincial veterinary agency has taken measures for quarantine and sterilization in order to stop the spread of the disease.

Since FMD was first reported in the northern province of Quang Ninh, more than 400 cattle have been culled as the province also suffered a shortage of vaccine against the epidemic.
(VOV News 3/12/2011)

^top


Americas
Canada: Botulism recall expands to all jam, jelly products
The British Columbia Centre for Disease Control (BCCDC) has expanded its recall to include all varieties of jam and jelly products prepared by Jamnation Fine Foods over fears of botulism.

On 8 March 2011, the BCCDC asked for the immediate disposal of Jamnation watermelon jelly that had been distributed in 120 mL-sized jars at various charity booths outside big box stores in Duncan as well as across the province as part of a Huntingtons Research Foundation fundraiser.

Eric Halstrom, president of the Huntington's Research Foundation, a non-profit society, said in a telephone interview from the Lower Mainland that his group sold 60 to 100 jars of the jelly. We do suspect it is an isolated incident, said Halstrom initially.

It turns out, after speaking with Jamnation representatives, the BCCDC believes there's an even wider concern. After conversations with the manufacturer, there is concern about other jam and jelly products prepared by Jamnation Fine Foods, explains Dr, Eleni Galanis, physician epidemiologist with BCCDC, an agency of the Provincial Health Services Authority. Anyone who may have purchased these products should discard them immediately.

A Vancouver Island woman is in stable condition at Victoria General Hospital after having consumed some of the watermelon jelly, a sample of which has tested positive for the botulism toxin.

[ProMED note: Home and even commercial foods that are preserved by canning techniques in cans or jars can transmit botulism. If not inactivated by the proper heating, spores of Clostridium botulinum can germinate and produce the neurotoxin which affects neurotransmission by blocking one of several steps in the neuronal synapse.

The incidence of the disease is low, but the mortality rate is high if not treated immediately and properly. Some cases of botulism may go undiagnosed because symptoms are transient or mild, or misdiagnosed as Guillain-Barre syndrome.]
(ProMED 3/17/2011)

^top

Chile (Aisen): First confirmed case in 2011 of Hantavirus infection
According to information from the Health SEREMI (Regional Ministerial Secretariat) official Claudio Vallejos, the Public Health Institute has confirmed the first Hantavirus infection cases in the region so far in 2011, referring to a 26 year old man who is gradually recuperating in the Coyhaique Hospital and his three year old daughter who has not had any further complications.
br> The Health SEREMI reported that, thanks to timely epidemiological work carried out in the land of the Guadal area by professionals of this institution, one can be assured that it is very likely that the infection was acquired in a home located in the La Lomita area of Guadal. Thus, the neighbors, and the rural population in general, must constantly assume safe behavior when taking on activities in the countryside.

The man was admitted 1 March 2011 to the intensive care unit of the Regional Hospital, where he was connected to a mechanical respirator because of severe respiratory insufficiency and acute pulmonary edema. Following up on this case, samples were taken from his wife and daughter. The daughter developed respiratory symptoms and fever on 13 February 2011 and received hospital treatment in the Cochrane locality on 18 February 2011. Both are out of danger.
(ProMED 3/10/2011)

^top

Peru (Amazonas): Rabies infection from exposure to rabid vampire bats
In Amazonas, an Awajun native has died with symptoms of rabies. The total of deaths due to sylvatic rabies is nine as of 9 March 2011. The 23 year old indigenous woman, who lived in the Yupicusa community in the Imaza region, died as a probable rabies case. With this death, the number of rabies deaths is raised to nine, including children and adults, due to the bite of vampire bats that are attacking Awajun and Wampis indigenous people living between Yupicusa and San Ramon, according to Dr. Orlando Caceres, director of the Bagua Health Network.

According to the victim's husband, their two year old daughter also died of sylvatic rabies on 2 February 2011. His wife had been bitten by bats on the right arm. Physicians attended her in Yupicusa, later her condition worsened and she died of the same symptoms that the daughter had.

The deceased received anti-rabies vaccine, and after being under observation she recovered for two weeks. But after that, she presented with symptoms of probable sylvatic rabies infection with fever, general malaise, body rigidity, and headache.

It is assumed that more children and adults have been bitten by bats, but the indigenous people prefer to go to traditional healers and are resistant to being vaccinated.

[ProMED note: Health services are very limited in their efforts and resources to be able to address this outbreak, which has killed nine people. The inaccessibility of the area and the limited resources also play their part. The strategy for intervention (in this case immunization and other preventive measures) must include the participation of other disciplines including anthropologists and social scientists. A disciplinary focus well delivered, must have a good approach to them and incorporate them into our civilization, but respect their beliefs and attitudes.

The vampire bat transmitted rabies outbreak has continued to smolder in this area since February 2011. Previous reports suggested that only children were involved. Now it is clear that adults have been affected as well. Given the reluctance for these indigenous people to seek medical attention and the remoteness of the area, one wonders if there is significant underreporting of cases.]
(ProMED 3/12/2011)

^top

USA (Ohio): Nosocomial Legionnaires’ disease
A ninth Miami Valley Hospital patient has tested positive for Legionnaires' disease, and one more possible case is pending test results, a hospital spokesman said on 8 March 2011.

One patient with Legionnaires' disease remains hospitalized for unrelated health reasons, said Tim Cloonan, the hospital's director of marketing and communications.

A Montgomery County public health official has said one patient – a Dayton man in his 70s -- died on 22 February 2011, but the hospital said Legionella bacteria did not cause that death. The public health official had previously said the death occurred on 21 February 2011. It's not clear if the pneumonia-like condition may have been a contributing factor in the death of the man, whose name was not disclosed.

The hospital has not yet received confirmation that Legionella bacteria had been present in the water system of its new hospital addition, called the "patient tower". Those results are expected 12 March 2011. The hospital instituted water restrictions in the patient tower for three days in February 2011 and disinfected the water system as a precaution.
(ProMED 3/10/2011)

^top

USA (Oregon): Hantavirus death confirmed in central Oregon
A hantavirus has been confirmed as the cause of death of a Deschutes County resident in central Oregon. The Deschutes County Health Department announced the death on 14 March 2011. No other details were available. Officials said it was the 16th case of Hantavirus infection confirmed in Oregon since 1993 and the fourth in Deschutes County.

Although rare in the United States, Hantaviruses can cause lung problems which can be fatal if not treated. The disease virus is carried primarily by rodents, especially the deer mouse Peromyscus maniculatus. The most common human exposure occurs during cleaning and working in spaces that have been inhabited by mice, such as garages, sheds, barns, and crawl spaces.
(Statesman Journal 3/14/2011)

^top

USA (Washington): Clark County investigates second child measles case in a month
A second case of measles within a month in Clark County, this one in a school-age child, is under investigation by health officials. The child was exposed at a medical facility visited by the first stricken child, a seven month old returned with his family from a trip to India, said Dr. Alan Melnick, the county health officer. The baby developed the telltale red measles rash while flying for more than 20 hours to Portland International Airport on 13 February 2011. He may have been coughing and sneezing -- the primary way the highly contagious disease is transmitted. The next day, the baby was taken to two medical facilities in Vancouver: the Evergreen Pediatric Clinic and the pharmacy or outpatient lab at the Southwest Washington Medical Center, officials said.

The school-age child had not been vaccinated when exposed, Melnick said. That child visited the 7-Eleven store at 5101 NE 112th Ave. in Vancouver between four and eight pm on 27 February 2011, while contagious. Health officials urged people who might have been exposed and have not been vaccinated to avoid going out in public for seven to 21 days following exposure. In this case, the period starts 6 March 2011 and runs to 20 March 2011. They also should seek vaccinations, although the vaccine is most effective within just three days of exposure. Pregnant women or people with immune system issues can receive immune globulin shots within six days of exposure.
(ProMED 3/8/2011)

^top

USA (Minnesota): Minneapolis baby treated for measles
Minnesota state health officials say they're investigating a case of measles that recently sent a Minneapolis infant to the hospital. Authorities said they are notifying people who may have come in contact with the child at Hennepin County Medical Center or at other specific settings. But they said the case poses little risk to the public because of the high rate of measles vaccination in Minnesota. The greatest risk is to those who may have been exposed to the child and have not been vaccinated, the State Health Department said.

It's the seventh time in five years that Minnesota has had a reported case of measles, a potentially deadly disease that can spread easily from person to person, according to the department. The child, who was not identified, is now recovering. This case reminds us of the importance of getting vaccinated for diseases, such as measles, which can be prevented with vaccines, said Dr. Ruth Lynfield, state epidemiologist.

Officials said the infant, who was too young to have been vaccinated, became ill in late February of 2011 and was probably infectious from 22 February 2011 to 2 March 2011. They're unsure where the child may have been exposed, because the family recently spent time in Chicago and Indiana before moving to Minneapolis.
(ProMED 3/8/2011)

^top

Australia: Measles scare at Gold Coast tourist spots
Queensland health authorities are concerned a teenage boy who became infected with measles might have spread it at two Gold Coast tourist spots. The boy is the latest Queenslander to contract the highly infectious virus. It's believed he caught it interstate. Anyone who was at White Water World on 22 February 2011 or Coolangatta Airport on 27 February 2011 afternoon who develops measles-like symptoms in the next week or two should contact their GP for advice, Gold Coast public health medical officer Dr. Don Staines said.

Queensland Health would continue to actively investigate the case, he said. Measles is one of the most infectious of all communicable diseases and can be acquired in public places through tiny droplets from coughing and sneezing. The virus can live for several hours in the environment.
(ProMED 3/8/2011)

^top

Australia: Warning on measles outbreak in Blacktown local government area
Residents have been warned of a measles outbreak in the Blacktown local government area. Dr. Vicky Sheppeard, manager, NSW Health Communicable Diseases for the public health unit said there had been 14 confirmed cases since the end of January 2011 at Rooty Hill, Seven Hills, Mt. Druitt and St. Marys.

We ask that people to ring ahead to say that they could have measles and ask to be seated in a separate waiting room to avoid spreading the disease to others. Measles is one of the most easily spread diseases and just being in the same room as someone with measles can result in infection. Around one in five people who catch measles require hospitalization, so it's better to prevent catching it if possible. The public health unit has been working with local hospitals, GPs and schools to identify and contact people who may have been exposed to the infection.
(ProMED 3/15/2011)

^top

Chinese Taipei: Health authorities warn of possible measles outbreak
Health authorities warned on 15 March 2011 of a possible measles outbreak in Taipei City's Wenshan District and told the residents there to be on guard after confirming three cases.

A spokesman for the Centers for Disease Control said genetic sequencing has tentatively confirmed a 28-year-old male Swiss student, a 20-year-old female Taiwanese student, and a one-year-old baby, all from Wenshan district, have contracted the highly contagious respiratory diseases from the same viral sources.

The baby, who contracted the disease from the female college coed earlier in March 2011, has been discharged from hospital in fair condition. Condition of the two grown-ups is not immediately known. The Swiss student lives about a ten-minute walk from the female student, and the two and the baby are total strangers to each other.

The Swiss student, who returned to Taiwan from India during the Lunar New Year break, appears to be the first of the three to come down with the disease. Next came the female student, whose onset is dated 16 February 2011. There was a two-day overlap in the two's incubation periods. The female student then passed the virus on to the baby, who has had contact with 155 people, one of whom is another baby who has never been immunized against measles with the so-called MMR vaccine. The second baby's condition also is not known.

CDC will continue to monitor the situation before confirming the disease is not spreading further.
(ProMED 3/15/2011)

^top


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

^top

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.

^top

VECTOR-BORNE DISEASE
Australia
Department of Health medical entomologist Sue Harrington said that the mosquito and virus surveillance program (undertaken by The University of Western Australia) had detected Kunjin virus in the Kimberley, and preliminary data indicated that the virus was also now active in the Pilbara region.

Recent heavy rainfall has resulted in large areas of standing water and the potential for mosquito breeding in many areas of the Kimberley, Pilbara, Gascoyne and Murchison regions. Surveillance results show that mosquitoes are carrying Kunjin virus, with activity of Murray Valley encephalitis (MVE) virus, also likely during the wet season months, Ms Harrington said. A number of cases of the more common Ross River virus and Barmah Forest virus diseases have already been reported from the Kimberley and Pilbara regions this wet season.

There are no specific cures or vaccines for these mosquito-borne diseases so it is very important that people take care to prevent being bitten by mosquitoes. Ms Harrington said controlling mosquitoes in most rural regions of Western Australia was generally not possible because of the large size and inaccessibility of natural mosquito breeding habitat.

[ProMED note: The unusual amount of precipitation has increased mosquito vector populations and virus circulation across wide areas of Australia. This has been anticipated by Australian health authorities, and the results of ongoing vector surveillance and sentinel chicken efforts are providing early warnings with appropriate recommendations for avoiding mosquito bites.]
(ProMED 3/5/2011)


Australia (Victoria)
Health officials say they have been unable to determine whether Murray Valley encephalitis virus infection caused the death of a Sunraysia man the week of 6 March 2011. The man died in hospital in Melbourne after showing symptoms of the mosquito-borne disease. The Health Department says there are no more test results pending, so the case is likely to remain a suspected case of Murray Valley encephalitis.

The disease has been showing in sentinel chickens in communities along the Murray River, but there have been no other reports in humans.

The department says there are now 600 cases of Ross River virus infections in Victoria, with about one third of cases coming from each of the Grampians and Loddon-Mallee regions.
(ABC News 3/16/2011)


Australia (North Queensland)
Queensland health authorities have embarked on a massive mosquito controlling drive following the identification of 53 cases of dengue fever in Innisfail, a place south of Cairns in north Queensland. Out of the 53 cases, 45 are type-2 dengue virus and eight are type-4.
(ProMED 3/13/2011)


Indonesia (Jakarta)
Since January to March 2011, the dengue fever case in North Jakarta reached 485 or lower compared to same period in 2010 by 723 cases.
(ProMED 3/6/2011)


Philippines (Pangasinan)
1 Mar 2011. The numbers of those afflicted with the dengue viral disease continue to climb in Pangasinan province in January and February of 2001 according to the local office of the Department of Health (DOH) on 1 March 2011. The DOH reports a total of 157 people have been found positive with dengue, resulting in three deaths thus far.
(ProMED 3/6/2011)


USA (Florida)
The second locally acquired case of dengue fever in Miami-Dade County was confirmed on 2 March 2011 by the county Health Department. The Health Department said the person showed symptoms of the illness, and lab tests confirmed it was dengue. The person has fully recovered from the symptoms, the health department said. The first case of locally acquired dengue in Miami-Dade was reported in November 2010. That person also fully recovered.
(ProMED 3/6/2011)


^top


4. Articles
Evaluating Research and Impact: A Bibliometric Analysis of Research by the NIH/NIAID HIV/AIDS Clinical Trials Networks
Rosas SR, Kagan JM, Schouten JT, et al. PLoS ONE. 4 March 2011;6(3):e17428.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21394198

Department of Health medical entomologist Sue Harrington said that the mosquito and virus surveillance program (undertaken by The University of Western Australia) had detected Kunjin virus in the Kimberley, and preliminary data indicated that the virus was also now active in the Pilbara region.

Recent heavy rainfall has resulted in large areas of standing water and the potential for mosquito breeding in many areas of the Kimberley, Pilbara, Gascoyne and Murchison regions. Surveillance results show that mosquitoes are carrying Kunjin virus, with activity of Murray Valley encephalitis (MVE) virus, also likely during the wet season months, Ms Harrington said. A number of cases of the more common Ross River virus and Barmah Forest virus diseases have already been reported from the Kimberley and Pilbara regions this wet season.

There are no specific cures or vaccines for these mosquito-borne diseases so it is very important that people take care to prevent being bitten by mosquitoes. Ms Harrington said controlling mosquitoes in most rural regions of Western Australia was generally not possible because of the large size and inaccessibility of natural mosquito breeding habitat.
[ProMED note: The unusual amount of precipitation has increased mosquito vector populations and virus circulation across wide areas of Australia. This has been anticipated by Australian health authorities, and the results of ongoing vector surveillance and sentinel chicken efforts are providing early warnings with appropriate recommendations for avoiding mosquito bites.]

^top

2008 outbreak of Salmonella Saintpaul infections associated with raw produce
Barton Behravesh C, Mody RK, Jungk J, et al. N Engl J Med. 10 March 2011;364(10):918-27. Epub 23 February 2011.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21345092

Background. Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008.

Methods. We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted.

Results. Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case-control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeño peppers were implicated in all three clusters with implicated ingredients, and jalapeño or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeño peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source.

Conclusions. Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.

^top

Atopy history and the genomics of wheezing after influenza vaccination in children 6–59 months of age
Miller EK, Dumitrescu L, Cupp C, et al. Vaccine. 9 March 2011. doi:10.1016/j.vaccine.2011.02.071.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-52BNBS6-1&_user=10&_coverDate=03%2F09%2F2011&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=18b14785e41a008e955b8f58eb0a122e&searchtype=a

Background. A multinational clinical trial compared the safety and efficacy of intranasal trivalent live attenuated influenza vaccine (LAIV) with intramuscular trivalent inactivated vaccine (TIV) in very young children prior to the 2004–5 influenza season [1]. Wheezing was noted more often in recipients of LAIV and laboratory-confirmed influenza infection was noted more often in recipients of TIV. We sought to determine whether epidemiologic or genetic factors were associated with these outcomes.

Methods. Atopy surveys and DNA collections were performed in trial participants at two United States sites, Nashville, TN and Boston, MA. DNA samples were genotyped on Illumina Infinium 610 or 660-Quad. Standard allelic tests of association were performed.

Results.At the Nashville and Boston sites, a total of 99 children completed the trial, 6 (1 TIV, 5 LAIV) developed medically attended wheezing within 42 days following vaccination, and 8 (5 TIV, 3 LAIV) developed laboratory-confirmed influenza during the season. Eighty-one surveys and 70 DNA samples were collected. Family history of asthma (p = 0.001) was associated with wheezing after vaccination. Of 468,458 single nucleotide polymorphisms tested in the genome-wide association study (GWAS), none achieved genome-wide significance for either wheezing after vaccination or laboratory-confirmed influenza infection.

Conclusions. Family history of asthma appears to be a risk factor for wheezing after influenza vaccination. Given the limitations of the sample size, our pilot study demonstrated the feasibility of performing a GWAS but was not able to determine genetic polymorphisms associated with wheezing after influenza immunization.

^top

Perceptions of and willingness to engage in public health precautions to prevent 2009 H1N1 influenza transmission
Kiviniemi MT, Ram PK, Kozlowski LT, et al. BMC Public Health. 8 March 2011; 11:152doi:10.1186/1471-2458-11-152
Available at http://www.biomedcentral.com/1471-2458/11/152

Background. Recommendations about precautionary behaviors are a key part of public health responses to infectious disease threats such as the 2009 H1N1 pandemic. Individuals' interpretation of recommendations, willingness to comply, and factors predicting willingness were examined.

Methods. A telephone survey of adult residents of New York State was conducted (N=807). Respondents reported how they interpreted recommendations, willingness to engage in recommended actions, risk perceptions for H1N1 infection, and perceived efficacy of recommendations. Demographic characteristics were used to calculate sampling weights to obtain population-representative estimates.

Results. There was substantial variability in interpretation of preventive actions. Willingness to engage in preventive actions also varied substantially; vaccination willingness was substantially lower than other preventive actions. No pattern of demographic characteristics consistently predicted willingness. Perceived efficacy was associated with willingness for all recommendations, and perceived severity was associated with willingness for some recommendations.

Conclusions. Results suggest that individual interpretation of actions differ widely. The results suggest that current recommendations are not clear to laypeople and are open to different interpretations. These varying interpretations should be considered in crafting public health messages about precautionary behaviors

^top

Factors Affecting Intention to Receive and Self-Reported Receipt of 2009 Pandemic (H1N1) Vaccine in Hong Kong: A Longitudinal Study
Liao Q, Cowling BJ, Wing Tak Lam W, et al. PLoS ONE. 11 March 2011; 6(3): e17713. doi:10.1371/journal.pone.0017713
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0017713

Background. Vaccination was a core component for mitigating the 2009 influenza pandemic (pH1N1). However, a vaccination program's efficacy largely depends on population compliance. We examined general population decision-making for pH1N1 vaccination using a modified Theory of Planned Behaviour (TBP).

Methodology. We conducted a longitudinal study, collecting data before and after the introduction of pH1N1 vaccine in Hong Kong. Structural equation modeling (SEM) tested if a modified TPB had explanatory utility for vaccine uptake among adults.

Principal Findings. Among 896 subjects who completed both the baseline and the follow-up surveys, 7% (67/896) reported being “likely/very likely/certain” to be vaccinated (intent) but two months later only 0.8% (7/896) reported having received pH1N1 vaccination. Perception of low risk from pH1N1 (60%) and concerns regarding adverse effects of the vaccine (37%) were primary justifications for avoiding pH1N1 vaccination. Greater perceived vaccine benefits (â = 0.15), less concerns regarding vaccine side-effects (â = −0.20), greater adherence to social norms of vaccination (â = 0.39), anticipated higher regret if not vaccinated (â = 0.47), perceived higher self-efficacy for vaccination (â = 0.12) and history of seasonal influenza vaccination (â = 0.12) were associated with higher intention to receive the pH1N1 vaccine, which in turn predicted self-reported vaccination uptake (â = 0.30). Social norm (â = 0.70), anticipated regret (â = 0.19) and vaccination intention (â = 0.31) were positively associated with, and accounted for 70% of variance in vaccination planning, which, in turn subsequently predicted self-reported vaccination uptake (â = 0.36) accounting for 36% of variance in reported vaccination behaviour.

Conclusions/Significance. Perceived low risk from pH1N1 and perceived high risk from pH1N1 vaccine inhibited pH1N1 vaccine uptake. Both the TPB and the additional components contributed to intended vaccination uptake but social norms and anticipated regret predominantly associated with vaccination intention and planning. Vaccination planning is a more significant proximal determinant of uptake of pH1N1 vaccine than is intention. Intention alone is an unreliable predictor of future vaccine uptake.

^top

Wild Bird Migration across the Qinghai-Tibetan Plateau: A Transmission Route for Highly Pathogenic H5N1
Prosser DJ, Cui P, Takekawa JY, et al. PLoS ONE. 9 March 2011; 6(3): e17622. doi:10.1371/journal.pone.0017622.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0017622

Background. Qinghai Lake in central China has been at the center of debate on whether wild birds play a role in circulation of highly pathogenic avian influenza virus H5N1. In 2005, an unprecedented epizootic at Qinghai Lake killed more than 6000 migratory birds including over 3000 bar-headed geese (Anser indicus). H5N1 subsequently spread to Europe and Africa, and in following years has re-emerged in wild birds along the Central Asia flyway several times.

Methodology/Principal Findings. To better understand the potential involvement of wild birds in the spread of H5N1, we studied the movements of bar-headed geese marked with GPS satellite transmitters at Qinghai Lake in relation to virus outbreaks and disease risk factors. We discovered a previously undocumented migratory pathway between Qinghai Lake and the Lhasa Valley of Tibet where 93% of the 29 marked geese overwintered. From 2003–2009, sixteen outbreaks in poultry or wild birds were confirmed on the Qinghai-Tibet Plateau, and the majority were located within the migratory pathway of the geese. Spatial and temporal concordance between goose movements and three potential H5N1 virus sources (poultry farms, a captive bar-headed goose facility, and H5N1 outbreak locations) indicated ample opportunities existed for virus spillover and infection of migratory geese on the wintering grounds. Their potential as a vector of H5N1 was supported by rapid migration movements of some geese and genetic relatedness of H5N1 virus isolated from geese in Tibet and Qinghai Lake.

Conclusions/Significance. This is the first study to compare phylogenetics of the virus with spatial ecology of its host, and the combined results suggest that wild birds play a role in the spread of H5N1 in this region. However, the strength of the evidence would be improved with additional sequences from both poultry and wild birds on the Qinghai-Tibet Plateau where H5N1 has a clear stronghold.

^top

Assessing the Ecotoxicologic Hazards of a Pandemic Influenza Medical Response
Singer AC, Colizza V, Schmitt H, et al. Environ Health Perspect. 2 March 2011; doi:10.1289/ehp.1002757.
Available at http://ehp03.niehs.nih.gov/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1289%2Fehp.1002757#Ahead%20of%20Print%20%28AOP%29

Background. The global public health community has closely monitored the unfolding of the 2009 H1N1 influenza pandemic to best mitigate its impact on society. However, little attention has been given to the impact of this response on the environment. Antivirals and antibiotics prescribed to treat influenza are excreted into wastewater in a biologically-active form, which presents a new and potentially significant ecotoxicologic challenge to microorganisms responsible for wastewater nutrient removal in wastewater treatment plants (WWPTs) and receiving rivers.

Objectives. Our objective was to assess the ecotoxicologic risks of a pandemic influenza medical response.

Methods. In order to evaluate this risk, we coupled a global spatially-structured epidemic model that simulates the quantities of antiviral and antibiotics used during an influenza pandemic of varying severity, with a water quality model applied to the Thames catchment to determine predicted environmental concentrations. An additional model was then used to assess the effects of antibiotics on microorganisms in WWTPs and rivers.

Results. Consistent with expectations, a mild pandemic was projected to exhibit a negligible ecotoxicologic hazard. In a moderate and severe pandemic, WWTP toxicity was projected to vary between 0-14% and 5-32% PAF, respectively, and river toxicity was projected to vary between 0-14 % and 0-30 % PAF, respectively, where PAF is the fraction of microbial species predicted to be growth-inhibited (lower and upper 95% RR).

Conclusions. The current pandemic influenza medical response might result in the discharge of insufficiently treated wastewater into receiving rivers, thereby increasing the risk of eutrophication and contamination of drinking water abstraction points. Widespread drugs in the environment could hasten the generation of drug resistance. These results highlight the need for empirical data on the effects of antibiotics and antiviral medications on WWTP and freshwater ecotoxicity.

^top

A Clinical Diagnostic Model for Predicting Influenza among Young Adult Military Personnel with Febrile Respiratory Illness in Singapore
Lee VJ, Yap J, Cook AR, et al. PLoS ONE. 2 March 2011; 6(3): e17468. doi:10.1371/journal.pone.0017468
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0017468

Introduction. Influenza infections present with wide-ranging clinical features. We aim to compare the differences in presentation between influenza and non-influenza cases among those with febrile respiratory illness (FRI) to determine predictors of influenza infection.

Methods. Personnel with FRI (defined as fever¡Ý37.5¡ãC, with cough or sore throat) were recruited from the sentinel surveillance system in the Singapore military. Nasal washes were collected, and tested using the Resplex II and additional PCR assays for etiological determination. Interviewer-administered questionnaires collected information on patient demographics and clinical features. Univariate comparison of the various parameters was conducted, with statistically significant parameters entered into a multivariate logistic regression model. The final multivariate model for influenza versus non-influenza cases was used to build a predictive probability clinical diagnostic model.

Results. 821 out of 2858 subjects recruited from 11 May 2009 to 25 Jun 2010 had influenza, of which 434 (52.9%) had 2009 influenza A (H1N1), 58 (7.1%) seasonal influenza A (H3N2) and 269 (32.8%) influenza B. Influenza-positive cases were significantly more likely to present with running nose, chills and rigors, ocular symptoms and higher temperature, and less likely with sore throat, photophobia, injected pharynx, and nausea/vomiting. Our clinical diagnostic model had a sensitivity of 65% (95% CI: 58%, 72%), specificity of 69% (95% CI: 62%, 75%), and overall accuracy of 68% (95% CI: 64%, 71%), performing significantly better than conventional influenza-like illness (ILI) criteria.

Conclusions. Use of a clinical diagnostic model may help predict influenza better than the conventional ILI definition among young adults with FRI.

^top


5. Notifications
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

^top

ISID-Neglected Tropical Diseases Meeting
Boston, Massachusetts, USA, 8-10 July 2011
The ISID-NTD meeting will be a rare opportunity to meet and interact with colleagues from around the world who are working to end debilitating diseases that afflict the world's poorest people. Learn from world leaders in the fields of global health, tropical medicine, public policy and social research about what is happening, and what still needs to happen, to eliminate these neglected diseases. Additional information at http://ntd.isid.org/

^top

Hot Topics 4 Video Symposium Highlights Video
Thank you for all that participated in the APEC EINet video symposium in December 2010. The video of the event highlights will be available on the EINet website as of Monday, 21 March 2011. We look forward to your participation in our future video symposia.
Additional information at http://depts.washington.edu/einet/symposium.html

^top

 apecein@u.washington.edu