Vol. XIV No. 8 ~ EINet News Briefs ~ Apr 15, 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 group renews push for pact on virus-sharing, pandemic vaccine access
- Global: WHO confirms five H5N1 influenza cases in Egypt, Bangladesh
- Global: FAO states that eliminating H5N1 influenza will take more than ten years
- Ireland: Narcolepsy concern prompts Ireland to pull remaining Pandemrix doses
- Australia: States hit hard with early influenza season
- South Korea: H5N1 avian influenza hits poultry farm
- Venezuela: H1N1 influenza outbreak continues to rise

2. Infectious Disease News
- Australia (Northern Territory): Record number of meliodiosis infections
- Australia: Unvaccinated travellers spreading measles outbreak
- India: Superbug found widely in water inside New Delhi
- India: Health Ministry states that there is no superbug hazard
- Philippines: Over 2,000 measles cases in three months
- Viet Nam: Hand foot and mouth disease outbreak worsens
- Canada (Ontario): Measles detected in student
- Chile (Maule): Hantavirus case
- Chile (Los Rios): New confirmed case of hantavirus
- USA: Outbreak of Human Salmonella typhimurium infections associated with water frogs contact
- USA (Minnesota): Measles outbreak grows to fifteen

3. Updates

4. Articles
- Spatial and temporal clusters of Barmah Forest virus disease in Queensland, Australia.
- Hand, foot and mouth disease: spatiotemporal transmission and climate.
- Pandemic influenza H1N1 2009 infection in Victoria, Australia: No evidence for harm or benefit following receipt of seasonal influenza vaccine in 2009
- Statistical estimates of absenteeism attributable to seasonal and pandemic influenza from the Canadian Labour Force Survey
- A Review of Adult Mortality Due to 2009 Pandemic (H1N1) Influenza A in California
- Evaluation of the implementation of the H1N1 pandemic influenza vaccine in local health departments (LHDs) in North Carolina
- A method for estimating vaccine preventable pediatric influenza pneumonia hospitalizations in developing countries: Thailand as a case study
- Assessing secondary attack rates among household contacts at the beginning of the influenza A (H1N1) pandemic in Ontario, Canada, April-June 2009: A prospective, observational study.
- Notes from the field: measles outbreak --- Hennepin County, Minnesota, February-March 2011
- Measles imported by returning U.S. travelers aged 6-23 months, 2001-2011
- How Climate Change May Make Killer Diseases Worse: Risk of Malaria, Other Diseases May Rise With Global Temperatures as Climate Changes

5. Notifications
- Keystone Symposia – Pathogenesis of Influenza: Virus-Host Interactions
- ISID-Neglected Tropical Diseases Meeting
- 5th Ditan International Conference on Infectious Diseases
- Public Health Preparedness Capabilities: National Standards for State and Local Planning
- International Meeting on Emerging Diseases and Surveillance (IMED 2011) Presentations

1. Influenza News

2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Bangladesh / 2 (0)
Cambodia / 4 (4)
Egypt / 22 (6)
Indonesia / 5 (4)
Total / 33 (14)

***For data on human cases of avian influenza prior to 2011, go to:

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 549 (320) (WHO 4/11/2011)

Avian influenza age distribution data from WHO/WPRO (last updated 2/7/2011):

WHO's map showing world's areas affected by H5N1 avian influenza (status as of 2/12/10):

WHO’s timeline of important H5N1-related events (last updated 4/4/11):


Global: WHO group renews push for pact on virus-sharing, pandemic vaccine access
Leaders from a World Health Organization (WHO) working group on virus sharing and vaccine issues related to pandemic preparedness said on 12 April 2011 that they hope to reach an agreement by Friday, 15 April 2011 so that it could go to the World Health Assembly (WHA) for a vote in May 2011.

The group's cochairs, ambassadors Bente Angell-Hansen from Norway and Juan Jose Gomez-Camacho from Mexico, briefed reporters in Geneva on 12 April 2011, where the working group is meeting the week of 11 April 2011 to finish what they hope is the final draft of the agreement.

In late 2006, virus sharing became an international flash point when Indonesia broke a long tradition of free international sharing of flu virus specimens by withholding its H5N1 virus samples as a protest against the high cost of commercial vaccines derived from such samples. The controversy has drawn attention to the problem of equitably distributing vaccines in the event of a pandemic.

In 2007 the WHO appointed a working group to hammer out an agreement to ease global virus-sharing issues, but so far problems such as intellectual-property rights and mechanisms for sharing the viruses and ensuring benefits for developing countries have stalled the group's progress.

Gomez-Camacho said that the WHO asked him and Angell-Hansen to take over leadership to get momentum going again. He said that over 2011 he and Angell-Hansen have conducted thorough consultations with governments, the pharmaceutical industry, and nongovernmental organizations (NGOs).

He said two major lessons of the 2009 H1N1 pandemic were that the world wasn't prepared for a severe pandemic and that the global community had a difficult time getting vaccine to developing countries. Gomez-Camacho said in some instances, developing countries lacked policies and infrastructure needed to accept donated vaccine.

The working group met with NGOs in February 2011 and sought written input from other such groups. Gomez-Camacho said the panel has had talks with pharmaceutical organizations from developing countries, and on 7 April 2011 held a private consultation with about 30 large companies. These meetings are taking place within the context of complex negotiations, he said, adding that the talks were sensitive, because of pricing and intellectual property issues.

We hope to wrap up the package by Friday, 15 April 2011 in our last round of negotiations, he said. Ideally the framework, if adopted by the WHA, would serve as a guidepost for pandemic virus-sharing and vaccine issues until 2016, after which technology advancements will likely require a review of the agreement and possible changes.

Angell-Hansen said the group is trying to build a flexible system that also shoots for more predictable vaccine production and sharing with developing countries. A major goal is to ensure a basic supply of pandemic vaccine for all countries, especially to protect healthcare workers and other key personnel. We don't want states crumbling if there's a pandemic with a high mortality rate, she said, adding that she hopes the pact produces a "push button" system that funnels vaccine to areas in need.

Such a system will require monitoring of where the world stands in terms of production, lab capacity, and adjuvant availability, she said. Industry officials project that the global pandemic vaccine capacity has grown to 1.1 billion doses, which will expand to 1.8 billion doses as new companies in developing countries start producing vaccine through their collaborations with major producers, according to Angell-Hansen.
(CIDRAP 4/12/2011)


Global: WHO confirms five H5N1 influenza cases in Egypt, Bangladesh
The World Health Organization (WHO) on 11 April 2011 confirmed four new H5N1 avian flu cases in Egypt—including a fatality—and one nonfatal case in Bangladesh.

The cases raise Egypt's H5N1 case total in 2011 to 22 and Bangladesh's to two. In addition, the WHO posted an official notice on 11 April 2011 of a Cambodia case that it had jointly confirmed with Cambodia's Ministry of Health the week of 4 April 2011.

The WHO revealed this information on the four Egyptian case-patients:
- A 20-year-old woman from Beheira governorate fell ill 14 March 2011 and was hospitalized 19 March 2011. She was listed in critical condition and died 28 March 2011.
- A 2-year-old girl from Menoufia governorate had symptoms 26 March 2011 and was hospitalized 27 March 2011. She is listed in stable condition and still under treatment.
- A 55-year-old woman from Beheira governorate first experienced symptoms 20 March 2011 and was hospitalized 22 March 2011. She recovered and was discharged 5 April 2011.
- A 1-year-old boy from Fayoum governorate first had symptoms 20 March 2011 and was hospitalized 28 March 2011. He is still under treatment in stable condition.

Source investigations revealed that all had exposure to sick or dead poultry suspected to have avian influenza, according to the WHO. In addition, all four had received oseltamivr (Tamiflu) in the hospital.

Between 28 March 2011 and 11 April 2011, the WHO has confirmed 11 Egyptian cases, including two fatalities. Five of those 11 patients have been from Beheira governorate. Of the 22 H5N1 cases in Egypt in 2011, six have been fatal. Since 2006 the country has logged 141 WHO-confirmed H5N1 cases and 46 deaths, second only to Indonesia (176) in total cases and third to Indonesia (145) and Vietnam (59) in fatal cases.

The WHO also reported that Bangladesh's Ministry of Health and Family Welfare has confirmed the country's second H5N1 case this year, in a 2-year-old boy from Kamalapur, Dhaka.

He experienced avian-flu symptoms 1 March 2011 1 and visited the country's influenza sentinel surveillance site on 9 March 2011, where samples were obtained. The country's Institute of Epidemiology, Disease Control and Research confirmed H5N1 in the samples. A detailed investigation revealed exposure to sick poultry but no other cases.

The WHO confirmed Bangladesh's previous case, in a 16-month-old girl, on 16 March 2011. On 11 April 2011, WHO states that although the case is from the same locality as the previous case they had no direct contact with each other. Bangladesh's only other H5N1 case was confirmed in 2008. It, too, was nonfatal.

On 11 April 2011, Cambodia's Ministry of Health in conjunction with the WHO has confirmed a fatal H5N1 case in an 11-year-old girl in the Steung Trang district of Kampong Cham Province.

She first experienced symptoms 22 March 2011 and was first treated by local villagers before being admitted to a local hospital 29 March 2011. Upon treatment failure she was transferred to a regional hospital 31 March 2011, where she died the same day. The report did not specify her treatment but said all contacts with the girl have tested negative for H5N1 infection.

Hers is the fourth H5N1 case in Cambodia in 2011, and all have proved fatal. Since 2005 the country has confirmed 14 H5N1 cases, including 12 deaths.

With the additional cases, the global H5N1 count has reached 549 cases and 320 deaths. Thirty-three of those cases and 14 of the deaths came in 2011.
(CIDRAP 4/11/2011)


Global: FAO states that eliminating H5N1 influenza will take more than ten years
Because of deep-rooted barriers, there is little chance that H5N1 avian influenza can be expelled within the next ten years from the six countries where it remains entrenched, the United Nations Food and Agriculture Organization (FAO) says.

Most of the 60-plus countries that reported H5N1 in 2006 have eliminated it since then, but it remains endemic in China, Vietnam, Indonesia, Bangladesh, India, and Egypt, notes the report, titled "Approaches to Controlling, Preventing and Eliminating H5N1 Highly Pathogenic Avian Influenza in Endemic Countries."

The FAO says the elimination effort faces three major obstacles in these countries: the structure of the poultry industry, the quality of veterinary and animal production services, and the level of commitment by all sectors.

Although measures have been introduced in all endemically infected countries to address these three factors, all require further long-term commitments and investment if the virus is to be eliminated. It is now generally accepted that the H5N1 highly pathogenic avian influenza (HPAI) virus is unlikely to be eliminated from poultry in these countries and regions for the next ten years at least. Further, there is no guarantee that the current incremental approach will eliminate H5N1 HPAI. The goal may require innovative measures such as new, easily deliverable poultry vaccines and genetic manipulation of poultry to make them resistant to the virus.

As long as H5N1 outbreaks continue, so will the risk of the virus evolving into a human pandemic strain. Several of the H5N1-endemic countries have had human H5N1 cases in 2011, with Egypt leading the list with 22 confirmed cases so far.

The full FAO report is available at http://www.fao.org/docrep/014/i2150e/i2150e.pdf
(CIDRAP 4/13/2011)


Europe/Near East
Ireland: Narcolepsy concern prompts Ireland to pull remaining Pandemrix doses
Ireland's health ministry has decided to pull all remaining supplies of Pandemrix, the monovalent pandemic H1N1 vaccine, from general practitioner (GP) offices because of the suspected link to narcolepsy cases, reported 3 April 2011. Eight narcolepsy cases have been reported in Pandemrix recipients in Ireland, most of them in young people. An increased risk of narcolepsy has also been reported in vaccinees in Finland and Sweden. Dr. Kevin Kelleher of the Irish Health Service Executive advised physicians in January not to use Pandemrix unless there was a shortage of seasonal flu vaccine (which contains the 2009 H1N1 strain). Kelleher told physicians that remaining supplies of Pandemrix would be picked up from GP sites in the next few weeks. He said there has been no need to use the monovalent vaccine because extra supplies of seasonal vaccine were delivered.
(CIDRAP 4/4/2011)


Australia: States hit hard with early influenza season
The southern Australian states of Victoria and South Australia are seeing an early influenza season that is producing four to five times the number of flu cases reported April 2010. Victoria's health department has confirmed 353 flu cases in 2011, compared with 67 as of April 2010. Flu specialist Dr. Alan Hampson attributed the phenomenon to increased rainfall, which may be keeping people indoors, as well as a mild flu season in 2010. In South Australia, lab-confirmed flu cases have reached 172, compared with 40 as of April 2010. University of Adelaide virologist Chris Burrell also attributed the surge to increased precipitation. What this means is that the upsurge that happens annually is coming earlier in 2011, he said. Health officials are stressing the importance of early vaccination.
(CIDRAP 4/6/2011)


South Korea: H5N1 avian influenza hits poultry farm
After only a two-week respite, South Korean officials confirmed on 8 April 2011 another outbreak of highly pathogenic H5N1 avian flu in poultry. Tests confirmed H5N1 in 13,200 birds at an egg-laying farm in Yeongcheon, 344 kilometers southeast of Seoul, according to the National Veterinary Research and Quarantine Service (NVRQS). The farm was placed under quarantine on 6 April 2011 after about 130 chickens died suddenly, and all of the farm's birds will be culled to prevent spread of the disease. The last avian flu outbreak in South Korean birds was confirmed 24 March 2011. The new outbreak is the country's 52nd since the disease resurged late in 2010. Officials have culled more than 6.27 million birds in six provinces across the country since late 2010.
(CIDRAP 4/8/2011)


Venezuela: H1N1 influenza outbreak continues to rise
At least 712 positive cases of influenza A/H1N1 virus infection and eight deaths were recorded in the country between 17 March and 7 April 2011, according to the health minister Eugenia Sader. The minister said that the deceased had severe pathologies. Patients suffering from hypertension, heart disease, are likely to react adversely to influenza virus infection.

Sader stressed that the epidemic barrier implemented in the state of Merida was a consequence of reappearance of the virus, which had affected 196 people, equivalent to 20 patients per 100 000 inhabitants in the state. She stated that in the case of the capital, Caracas, there were 174 cases, with eight out of 100,000 affected.

Meanwhile, the national government through the MOH has implemented a prevention and vaccination campaign, focusing on the population considered to be at risk (the elderly, pregnant women and people with respiratory or immune diseases).
(ProMED 4/7/2011)


2. Infectious Disease News

Australia (Northern Territory): Record number of meliodiosis infections
The Health Department is warning about the ongoing risk posed by a potentially deadly soil disease, which has infected 56 people in the Northern Territory this wet season. Melioidosis claims a number of lives each year in the Territory but its impact has been more significant in the past two wet seasons with a record number of infections, including some in Central Australia.

It is caused by bacteria that live deep in the soil of the Top End (the northern portion of the Northern Territory) during the dry season but come to the surface with water and mud after heavy rainfall, explained Centre for Disease Control director Dr. Vicki Krause. Melioidosis can cause severe pneumonia and blood infection, particularly in people with underlying health conditions that impair the immune system.

People can become infected by walking in muddy water, handling muddy items, or breathing air-borne particles while using high-powered hoses. Dr. Krause advised people to take precautions against the disease by wearing waterproof shoes, gloves, and masks when gardening or cleaning up after floods.

People most at risk include those with underlying conditions, such as diabetes, heavy alcohol intake, cancer, advanced age, kidney or lung disease, and those being treated for cancer and on long-term steroid therapy medicines.
(ProMED 4/12/2011)


Australia: Unvaccinated travellers spreading measles outbreak
An outbreak of measles is being spread by unvaccinated travellers who bring the deadly disease home with them. Western Sydney and Wollongong are hot spots with 45 cases already reported in 2011, more than the total number of cases reported each year since 2007.

Pockets of New South Wales (NSW) are recording outbreaks, with at least 23 cases reported in Rooty Hill, St. Mary's, Mt. Druitt, and Seven Hills. Health authorities are worried it is spreading because young adults are not properly vaccinated and are travelling to Europe and other countries where it is still common. The potentially deadly disease has almost been eliminated from Australia, where it is now considered travel-acquired with no home-grown cases detected here.

But many people aged 25 to 40 are not protected, even though they believe they are. When the vaccination was first introduced in 1966, it was thought one dose was needed, NSW Health communicable diseases manager Vicky Sheppeard said. We now know two doses are needed, and we are struggling to get that information out so young adults who are travelling know that they need to get two doses.

At least seven recent cases were caused by young Australians returning from overseas and then passing on the highly-infectious disease to children or family members. Others have come into contact with measles while in a doctor's surgery or hospital.

Wollongong is in the grips of an outbreak, while doctors believe they have reduced the spread in western Sydney. Children can't be vaccinated until they are aged one but then need a follow up when they are four. We have seen mini-outbreaks in families, Dr Sheppeard said. Unfortunately in 2011, some travellers have come back into communities where children have not been fully vaccinated, or a family member is not, and we've seen measles spread in pockets. Dr Sheppeard said there was no indication to suggest measles was spreading because of some parents' opposition to vaccination. General practitioners and travel clinics have been placed on high alert for people about to head overseas. National Centre for Immunisation Research and Surveillance director Professor Peter McIntyre said travellers in their mid-20s should be getting vaccinated: You don't need to go to some exotic location; you could pick it up in Europe.
(ProMED 4/5/2011)


India: Superbug found widely in water inside New Delhi
A deadly superbug has been found in about a quarter of water samples taken from drinking supplies and puddles on the streets of New Delhi. Experts say it's the latest proof that the new drug-resistant bacteria, known as NDM-1, named for New Delhi, is widely circulating in the environment and could potentially spread to the rest of the world. The superbug can only be treated with a couple of highly toxic and expensive antibiotics.

Since it was first identified in 2008, it has popped up in a number of countries, including the United States, Australia, Britain, Canada and Sweden. Most were in people who had recently traveled to or had medical procedures in India, Pakistan or Bangladesh. This is not a problem that is looming in the future. There are people dying today from infections that can't be treated, said David Heymann, chairman of Britain's Health Protection Agency.

Last fall, British scientists analyzed more than 200 water samples from central New Delhi, including public tap water and water that collected in the streets. They found the superbug gene in two of the drinking water samples and 51 of the street samples. As a comparison, the scientists also took 70 water samples from a water treatment center in Cardiff, Britain. No superbug genes were found in any of those. The research was paid for by the European Union and was published online in the journal Lancet Infectious Diseases.

Mark Toleman, a senior research fellow at Cardiff University and one of the study authors, said about a half million people in New Delhi are now carrying the superbug gene naturally in their gut bacteria. Some experts weren't so sure how prevalent the NDM-1 superbug could become. The fact that NDM-1 has emerged is worrisome, said Guenael Rodier, director of communicable diseases at the World Health Organization's office in Copenhagen. But forecasting what it will do is very difficult. He explained that was because resistant strains sometimes mysteriously disappear.
(Seattle Times 4/6/2011)


India: Health Ministry states that there is no superbug hazard
There is no major health threat by the presence of multi-drug resistant bacteria in Delhi's environment, the Union Health Ministry said on Monday 11 April 2011.

A UK based prestigious medical journal has accused the Indian government of suppressing the truth about the presence of the superbug. We have rejected it and we still reject it, Director General Health Service RK Srivastava said. However, he said that a final statement can be made only after the research wing of the Health Ministry (Indian Council of Medical Research) completes its study. The research wing will examine everything, the protocol and the method of research, all will be examined and only after that, a final statement can be given by the concerned authorities, he said.

Days after Health Ministry rejected the study on the presence of the superbug in Delhi's environment, published in the British journal The Lancet, study co-author Mark Toleman accused the government of India of suppressing the truth.

The study, published the week of 4 April 2011, said the New Delhi metallo-beta-lactamase (NDM-1) gene, which makes bacteria resistant to an array of antibiotics, including the most powerful ones, has been found in open water pools, water from overflowing sewage and even a couple of drinking water samples in the Indian capital.

The health ministry, however, said such bacteria existed all over the world and the study was targeting India. Delhi Chief Minister Sheila Dikshit also reiterated on 11 April 2011 that water in the city was safe for drinking and there was nothing to panic about.

[ProMED note: Indeed, panic should not be the response to the report. While it is the truth that NDM-1 gene containing bacteria have been found around the world, most of the cases have been traced back to the Indian subcontinent where, in New Delhi, the gene cassette was first identified. Furthermore, the danger represented by such antimicrobial-resistant bacteria needs to be stratified. That is, an extremely resistant E. coli in the intestines of a healthy individual is not an immediate danger to the host. Indeed, it can be part of the microflora of the gut which serves a positive role in health. How well the NDM-1-containing enterobacteriacae compete in the gut is not clear and may not be able to survive well against their drug-sensitive cousins.

Those points must be taken in perspective should the polydrug-resistant organism escape the nurturing environment of the gut and cause a urinary tract infection by traversing the urethra or enter the sterile peritoneum via a ruptured appendix or diverticulum. In such circumstances, appropriate antimicrobial intervention is extremely limited and can certainly lead to increased morbidity and mortality.

The widespread misuse of antimicrobial agents plays a large role in the selection on such isolates. An inadequate sanitary system, allowing human waste to contaminate water supplies, further serves to spread the resistant strains.]
(ProMED 4/12/2011)


Philippines: Over 2,000 measles cases in three months
In just the first three months of 2011, over 2,000 cases of measles have already been recorded in the country. Five of these resulted in death.

The majority of the cases are in the National Capital Region (311 cases). The rest are in Central Luzon (298), Bicol region (277), Calabarzon (238), Davao region (197), Ilocos region (174), and Zamboanga peninsula (163). In the National Capital Region, most of the cases are in Manila (101). Quezon City, meanwhile, had 50 cases, while Caloocan had 36.

To address this problem, the Department of Health (DOH) launched on 4 April 2011 a month-long nationwide campaign "Iligtas sa Tigdas ang Pinas", a vaccination campaign targeting children aged nine months up to eight years old. The campaign hopes to curb the rising incidence of measles cases, which reached 6,000 in 2010. Vaccination teams dubbed "bakunadoors" will go door-to-door to administer free vaccinations.
(ProMED 4/11/2011)


Viet Nam: Hand foot and mouth disease outbreak worsens
The number of children in Ho Chi Min (HCM) City coming to hospitals with hand foot and mouth disease (HFMD) has been increasing steadily in the last two weeks, according to doctors. Dr. Truong Huu Khanh, head of the infectious and neurological diseases ward at the Paediatric Hospital No.1, said the number of children being hospitalized every day has almost doubled the average 20 in the recent past. On Thursday, 7 April 2011 alone, 35 were admitted, five in serious condition and requiring a respirator. One child died due to severe complications after being admitted to hospital late.

The Pediatric Hospital No.2 admitted 27 children on Thursday 7 April 2011. Dr. Nguyen Dac Tho, deputy head of the city Preventive Medicine Centre, said from an average of 30 per day in the last two weeks, the number has increased to 80. So far in 2011, out of the 600 children who contracted the disease, mostly belonging to the City, three had died.

Doctors are worried since usually there are no fatalities in the early part of the year. Normally the disease peaks between October and December though there are also many cases in the period from March to May.

There is no vaccine against HFM disease and the best preventive method was keeping the environment, food, and drinks hygienic, he said. He urged local preventive medicine centers to strengthen preventive measures against this and other infectious diseases, especially at schools, including propaganda about preventive methods. The Department of Education and Training has also ordered kindergartens to carry out preventive measures against HFM and other infectious diseases.
(ProMED 4/9/2011)


Canada (Ontario): Measles detected in student
The Hastings and Prince Edward Counties Health Unit has confirmed a case of measles in a young student in Hastings County. Unit staff said they are investigating where the child may have contracted the illness and are taking steps to prevent it from spreading to others. Since the immunization rate in Ontario is high, the risk to the general public is considered low, said the staff, reporting a 92% immunization rate among school-age children.
(ProMED 4/5/2011)


Chile (Maule): Hantavirus case
The Public Health Institute confirmed a new case of a hantavirus infection in the San Javier area in the Maule region. The case is a 54-year-old agricultural worker who died 1 April 2011 and who, on 5 April 2011 was confirmed as a positive hantavirus infection case by the Public Health Institute.

It is worth mentioning that three hantavirus infection cases have been registered in 2011 in the Maule region, of which two have been mild and one with a fatal outcome.
(ProMED 4/6/2011)


Chile (Los Rios): New confirmed case of hantavirus
The new case of a hantavirus infection was confirmed in Valdivia, which brings to five the number of people infected with the disease, all from the Corral community. This latest case is a 34-year-old man, whose wife is a port community hospital staff member who was also positive for a hantavirus infection, and who was admitted the Valdivia Regional Hospital.

This information was confirmed by the Health SEREMI staff member Richard Rios, who stated that before the presence of the virus was confirmed, the patient was treated as such preventively, given the relationship with the confirmed case. The man remains in the intensive care unit of the previously mentioned health facility. His condition is guarded and he is breathing on his own without a mechanical respirator.

Meanwhile, in relation to the brief closure of the Los Pellines rural medical station in the Niebla locality due to the presence of rodents in the facility, the regional ministerial secretary stated that work is underway to improve the situation and it is the assistance network of the Health Services that will define the time of the station's closure.
(ProMED 4/7/2011)


USA: Outbreak of Human Salmonella typhimurium infections associated with water frogs contact
The Centers for Disease Control and Prevention (CDC) is collaborating with public health officials in many states to investigate a multi-state outbreak of human Salmonella typhimurium infections associated with contact with water frogs, such as African dwarf frogs. Water frogs commonly live in habitats such as aquariums or fish tanks.

As of 5 April 2011, a total of 217 individuals infected with the outbreak strain of S. typhimurium have been reported from 41 states since 1 April 2009. The number of ill person identified in each state is as follows: Alaska (5), Alabama (2), Arizona (10), California (17), Colorado (12), Connecticut (3), Florida (1), Georgia (4), Idaho (4), Illinois (8), Indiana (1), Kansas (2), Kentucky (4), Louisiana (2), Massachusetts (6), Maryland (5), Michigan (6), Minnesota (1), Missouri (5), Mississippi (1), Montana (2), North Carolina (1), Nebraska (2), New Hampshire (3), New Jersey (3), New Mexico (2), Nevada (3), New York (7), Ohio (7), Oklahoma (1), Oregon (5), Pennsylvania (14), South Dakota (3), Tennessee (4), Texas (4), Utah (18), Virginia (11), Vermont (1), Washington (23), Wisconsin (3), and West Virginia (1).

Among the persons for whom information is available, illnesses began 9 April 2009. Infected individuals range in age from less than 1 year old to 73 years old; 71% of patients are younger than 10 years old, and the median age is 5 years old. 51% of patients are female. Among ill persons, 34% were hospitalized. No deaths have been reported.

Surveillance for additional illness continues through analysis of data in PulseNet, the national network of public health and food regulatory agency laboratories coordinated by the Centers for Disease Control and Prevention (CDC).
(ProMED 4/7/2011)


USA (Minnesota): Measles outbreak grows to fifteen
There is another confirmed case of the measles in Minnesota. The Minnesota Department of Health is now reporting 15 cases of measles. Twelve of the cases have been linked to a person who contracted the measles in Kenya. One case was contracted in Florida and the latest in India.

Those who have come down with the measles range in age from 4 months to 51 years old. In five of the cases the person was too young to receive vaccine. Six were old enough, but were not vaccinated. At least one was vaccinated. For the other three it is unclear whether they received the vaccination or not. So far, eight people have been hospitalized, but no deaths have been reported.
(ProMED 4/11/2011)


3. Updates
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


- 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.


Australia (Torres Strait Islands)
Health authorities say they have detected another case of malaria in the Torres Strait. Four people became ill on Saibai and Dauan islands in March 2011, and authorities were optimistic the outbreak had been contained. But a fifth case of malaria has now been detected.
(ProMed 4/6/2011)

Australia (Western Australia)
The Health Department says Western Australia's (WA) north is on track to record its worst year for Ross River virus. 613 West Australians have contracted the disease since July 2010 with almost twice as many people contracting the mosquito-borne disease compared to 2009 when there were 339 cases. Infection rates sky-rocketed in Perth, the South West, and the far north in recent months. In 2010, 105 people in the South West contracted the virus while 199 cases have been recorded for 2011.

Infection rates have quadrupled in the Kimberley from 28 people to 116 for 2011. In the Kimberley, the increase is being blamed on a heavier than usual wet season. Medical entomologist Sue Harrington says the situation will worsen in coming weeks. Harrington states that this is really, at the end of the wet season, the time when you start to see the cases coming in, and certainly the figures for January and February 2011 is high. If we keep getting Ross River virus infection cases coming in at the rate we're getting them for 2011, it's going to be a pretty extreme year for the Kimberley. Most of the infections in the Kimberley have occurred in Broome, where the local shire says it is undertaking a spraying program for mosquitoes.

Meanwhile, the Health Department has confirmed a Carnarvon resident has recorded the 1st case in WA in two years of an unusual mosquito-borne disease. The person has been diagnosed with Murray Valley encephalitis virus infection. The department is investigating several other possible cases of the virus in the Pilbara and Kimberley. Murray Valley encephalitis can cause severe illness and can be fatal if not treated correctly.
(ABC News 4/12/2011)

Health Secretary Enrique Ona has warned that the country (Philippines) may witness a far worse outbreak of dengue fever for 2011 based on a dramatic peak in the number of cases last January and February 2011.

In his message during 28 March 2011’s Dengue Summit at the Grand Opera Hotel in Manila, Ona noted that 13,281 dengue cases have already been admitted in government hospitals during the first two months of 2011. 63 deaths have been reported so far. Ona said the World Health Organization has warned that the Philippines and other member countries in the Western Pacific Region may be headed for another dengue crisis unless urgent measures are taken and stronger political commitment is effectively put in place in affected communities. He noted that serious outbreaks continue to occur in highly endemic regions, particularly in the Asia-Pacific which already account for 70% of all dengue cases.

Ona stated that the threat of dengue is increasing at a particularly alarming rate and into new geographic areas where it was not found before. He noted that new outbreaks are exploding as temperatures warm and rains come in longer and earlier, expanding the lifespan of the dengue epidemic each season. He said climate change, rapid urbanization, and international travel have all made dengue the world’s most important viral vector-borne disease and the country’s most disturbing health concern among all reemerging infectious diseases. Because of this, Ona said the DoH had considered dengue as a year-round public health threat since 2006.

Last January 2011, the DoH embarked on an early offensive against dengue by launching the Nationwide Anti-dengue campaign starting in Metro Manila followed by similar initiatives in the high-burden provinces and regions of the country. Ona cited the need for the cooperation of local authorities to better fight the menace. He said key interventions against dengue —such as primary preventive action—must stem from the affected and at-risk communities.

In the absence of usual cures and vaccines, he cited the need to rely on the basics of early prevention and community action. In the same summit, health officials called on barangay captains to formulate ordinances or resolutions in the fight against dengue in the barangay level.
(Manila Standard TODAY 4/4/2011)

USA (Oahu, Hawaii)
Twelve more possible cases of dengue fever have been reported by physicians to the state Department of Health since two confirmed and two unconfirmed cases were announced the week of 13 March 2011. The confirmed cases were from two people who live in the same Pearl City neighborhood, and were the first known Hawaii cases of locally contracted dengue fever since a 2001 outbreak in which 153 people were infected with the mosquito-borne viral illness.
(ProMED 4/4/2011)


Papua New Guinea (New Ireland)
The fight against cholera is still far from over. It has emerged in Lihir, New Ireland Province, where the first confirmed case was detected and reported on 28 March 2011 by the chairman for New Ireland Provincial Cholera Task Force (NIPCTF) Alphonse Wena.

Mr. Wena said an Australian working for Lihir Gold Mines was tested positive after being rushed to the Lihir Medical Center following severe diarrhea associated with continuous vomiting. The patient received treatment and was isolated but is recovering in hospital.

Mr. Wena said the expatriate's contacts were also screened and treated despite their negative status. He said the cholera task force held a briefing on 30 March 2011 to address the issue to its members.
(ProMED 4/4/2011)

Papua New Guinea (Bougainville)
Tests in Port Moresby have confirmed a cholera epidemic in Bougainville province, particularly the northern tip of Buka Island. Already 65 cases have been treated at the Lemanmanu medical command post.

Fifteen cases required admission and have already been treated and discharged. The death toll still stands at two but the disease has spread across Gogohe and Hutjena and those affected were sent back to Haku, where the disease started. The Cholera Task Force is now looking at strict measures to contain the epidemic from causing more deaths and to further prevent it from spreading all over Bougainville.

The age groups most affected are between the ages of 10-15 year olds and most cases reported revealed that more girls are affected.
(ProMED 4/4/2011)

Philippines (Manila)
A state of calamity has been declared at the Bataraza town in Palawan due to the cholera outbreak that already killed 19 people. The government has released an estimated P4 million from the calamity fund to assist Bataraza.

Earlier tests done by the Department of Health (DOH) showed the patients were positive for cholera-causing bacteria, which has affected 17 out of 25 barangays in Bataraza.

Diarrhea cases in Palawan have reached 430, with the worst cases reported in Barangay Calandanum. The lack of proper toilets in the community may have been the cause of the outbreak. The DOH assured the public that the outbreak will not spread to other parts of Palawan. Bataraza town is around 225 kms away from Puerto Princesa City.

Dr. Eric Tayag, chief of DOH-National Epidemiology Center, admitted that providing potable drinking water to the area is a challenge. The water source in Bataraza has already been contaminated. However, the health department is already conducting alternative methods to provide potable water and has recommended the rationing of potable water from other areas.

Tayag stated that they are looking at the long term. They are working with LWUA (Local Water Utilities Administration) and the local government to focus on sanitation. If there is no proper sanitation, the problem will not go away.
(ABS-CBN News 4/14/2011)


4. Articles
Spatial and temporal clusters of Barmah Forest virus disease in Queensland, Australia.
Naish S, Hu W, Mengersen K et al. Trop Med Int Health. 11 April 2011; doi: 10.1111/j.1365-3156.2011.02775.x.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21481107

Objective. To identify the spatial and temporal clusters of Barmah Forest virus (BFV) disease in Queensland in Australia, using geographical information systems and spatial scan statistic (SaTScan).

Methods. We obtained BFV disease cases, population and statistical local areas (SLAs) boundary data from Queensland Health and Australian Bureau of Statistics, respectively, during 1992-2008 for Queensland. A retrospective Poisson-based analysis using SaTScan software and method was conducted to identify both purely spatial and space-time BFV disease high-rate clusters. A spatial cluster size of a proportion of the population and a 200 km radius and varying time windows from 1 to 12 months were chosen (for the space-time analysis).

Results. The spatial scan statistic detected a most likely significant purely spatial cluster (including 23 SLAs) and a most likely significant space-time cluster (including 24 SLAs) in approximately the same location. Significant secondary clusters were also identified from both the analyses in several locations.

Conclusions. This study provides evidence of the existence of statistically significant BFV disease clusters in Queensland, Australia. The study also demonstrated the relevance and applicability of SaTScan in analysing ongoing surveillance data to identify clusters to facilitate the development of effective BFV disease prevention and control strategies in Queensland, Australia.


Hand, foot and mouth disease: spatiotemporal transmission and climate.
Wang JF, Guo YS, Christakos G et al. Int J Health Geogr. 5 April 2011; 10(1):25 [Epub ahead of print].
Available at http://www.ij-healthgeographics.com/content/10/1/25/abstract

Background. The Hand-Foot-Mouth Disease (HFMD) is the most common infectious disease in China, its total incidence being around 500,000 ~1,000,000 cases per year. The composite space-time disease variation is the result of underlining attribute mechanisms that could provide clues about the physiologic and demographic determinants of disease transmission and also guide the appropriate allocation of medical resources to control the disease. Methods and Findings HFMD cases were aggregated into 1456 counties and during a period of 11 months. Suspected climate attributes to HFMD were recorded daily at 740 stations throughout the country and subsequently interpolated within 145611 cells across space-time (same as the number of HFMD cases) using the Bayesian Maximum Entropy (BME) method while taking into consideration the relevant uncertainty sources. The dimensionalities of the two datasets together with the integrated dataset combining the two previous ones are very high when the topologies of the space-time relationships between cells are taken into account. Using a self-organizing map (SOM) algorithm the dataset dimensionality was effectively reduced into 2 dimensions, while the spatiotemporal attribute structure was maintained. 16 types of spatiotemporal HFMD transmission were identified, and 3-4 high spatial incidence clusters of the HFMD types were found throughout China, which are basically within the scope of the monthly climate (precipitation) types.

Conclusions. HFMD propagates in a composite space-time domain rather than showing a purely spatial and purely temporal variation. There is a clear relationship between HFMD occurrence and climate. HFMD cases are geographically clustered and closely linked to the monthly precipitation types of the region. The occurrence of the former depends on the later.


Pandemic influenza H1N1 2009 infection in Victoria, Australia: No evidence for harm or benefit following receipt of seasonal influenza vaccine in 2009
Kelly HA, Grant KA, Fielding JE et al. Vaccine. 4 April 2011; doi:10.1016/j.vaccine.2011.03.055.
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-52JCBGK-4&_user=10&_coverDate=04%2F05%2F2011&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2189b8e749a9520f4ccb47874c01401f&searchtype=a

Abstract. Conflicting findings regarding the level of protection offered by seasonal influenza vaccination against pandemic influenza H1N1 have been reported. We performed a test-negative case control study using sentinel patients from general practices in Victoria to estimate seasonal influenza vaccine effectiveness against laboratory proven infection with pandemic influenza. Cases were defined as patients with an influenza-like illness who tested positive for influenza while controls had an influenza-like illness but tested negative. We found no evidence of significant protection from seasonal vaccine against pandemic influenza virus infection in any age group. Age-stratified point estimates, adjusted for pandemic phase, ranged from 44% in persons aged less than 5 years to −103% (odds ratio = 2.03) in persons aged 50–64 years. Vaccine effectiveness, adjusted for age group and pandemic phase, was 3% (95% CI −48 to 37) for all patients. Our study confirms the results from our previous interim report, and other studies, that failed to demonstrate benefit or harm from receipt of seasonal influenza vaccine in patients with confirmed infection with pandemic influenza H1N1 2009.


Statistical estimates of absenteeism attributable to seasonal and pandemic influenza from the Canadian Labour Force Survey
Schanzer DL, Zheng H, Gilmore J. BMC Infectious Diseases. 12 April 2011; 11:90; 90doi:10.1186/1471-2334-11-90
Available at http://www.biomedcentral.com/1471-2334/11/90

Background. As many respiratory viruses are responsible for influenza like symptoms, accurate measures of the disease burden are not available and estimates are generally based on statistical methods. The objective of this study was to estimate absenteeism rates and hours lost due to seasonal influenza and compare these estimates with estimates of absenteeism attributable to the two H1N1 pandemic waves that occurred in 2009.

Methods. Key absenteeism variables were extracted from Statistics Canada's monthly labour force survey (LFS). Absenteeism and the proportion of hours lost due to own illness or disability were modelled as a function of trend, seasonality and proxy variables for influenza activity from 1998 to 2009.

Results. Hours lost due to the H1N1/09 pandemic strain were elevated compared to seasonal influenza, accounting for a loss of 0.2% of potential hours worked annually. In comparison, an estimated 0.08% of hours worked annually were lost due to seasonal influenza illnesses. Absenteeism rates due to influenza were estimated at 12% per year for seasonal influenza over the 1997/98 to 2008/09 seasons, and 13% for the two H1N1/09 pandemic waves. Employees who took time off due to a seasonal influenza infection took an average of 14 hours off. For the pandemic strain, the average absence was 25 hours.

Conclusions. This study confirms that absenteeism due to seasonal influenza has typically ranged from 5% to 20%, with higher rates associated with multiple circulating strains. Absenteeism rates for the 2009 pandemic were similar to those occurring for seasonal influenza. Employees took more time off due to the pandemic strain than was typical for seasonal influenza.


A Review of Adult Mortality Due to 2009 Pandemic (H1N1) Influenza A in California
Louie JK, Jean C, Acosta M et al. PLoS ONE. 5 April 2011; 6(4): e18221; doi:10.1371/journal.pone.0018221
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0018221

Background. While children and young adults had the highest attack rates due to 2009 pandemic (H1N1) influenza A (2009 H1N1), studies of hospitalized cases noted high fatality in older adults. We analyzed California public health surveillance data to better characterize the populations at risk for dying due to 2009 H1N1.

Methods and Findings. A case was an adult ≥20 years who died with influenza-like symptoms and laboratory results indicative of 2009 H1N1. Demographic and clinical data were abstracted from medical records using a standardized case report form. From April 3, 2009 – August 10, 2010, 541 fatal cases ≥20 years with 2009 H1N1 were reported. Influenza fatality rates per 100,000 population were highest in persons 50–59 years (3.5; annualized rate = 2.6) and 60–69 years (2.3; annualized rate = 1.7) compared to younger and older age groups (0.4–1.9; annualized rates = 0.3–1.4). Of 486 cases hospitalized prior to death, 441 (91%) required intensive care unit (ICU) admission. ICU admission rates per 100,000 population were highest in adults 50–59 years (8.6). ICU case-fatality ratios among adults ranged from 24–42%, with the highest ratios in persons 70–79 years. A total of 425 (80%) cases had co-morbid conditions associated with severe seasonal influenza. The prevalence of most co-morbid conditions increased with increasing age, but obesity, pregnancy and obstructive sleep apnea decreased with age. Rapid testing was positive in 97 (35%) of 276 tested. Of 482 cases with available data, 384 (80%) received antiviral treatment, including 49 (15%) of 328 within 48 hours of symptom onset.

Conclusions. Adults aged 50–59 years had the highest fatality due to 2009 H1N1; older adults may have been spared due to pre-existing immunity. However, once infected and hospitalized in intensive care, case-fatality ratios were high for all adults, especially in those over 60 years. Vaccination of adults older than 50 years should be encouraged.


Evaluation of the implementation of the H1N1 pandemic influenza vaccine in local health departments (LHDs) in North Carolina
DiBiase LM, Davis SE, Rosselli R et al. Vaccine. 6 April 2011; doi:10.1016/j.vaccine.2011.03.085
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-52JKK69-4&_user=10&_coverDate=04%2F06%2F2011&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=947efd3cd4024d99f08356901111f61a&searchtype=a

Introduction. Effective conduct of vaccination campaigns by public health authorities can reduce morbidity and mortality associated with influenza. The emergence of the pandemic H1N1 influenza in April 2009 resulted in an unprecedented vaccination campaign in the US during the 2009–2010 influenza season. The variety of methods local health departments (LHDs) utilized to cope with a mismatch between public demand and supply and ever-changing guidelines have gone unexamined thus far. The purpose of this research is to identify and share lessons learned related to H1N1 influenza vaccination activities at LHDs.

Methods. In April 2010, a comprehensive survey was developed to evaluate 2009-10 LHD H1N1 vaccination practices and document lessons learned. A stratified random sample was selected from NC's 85 LHDs. Interviews were conducted with key personnel involved in LHD vaccination campaigns. Results were analyzed to identify quantitative trends and qualitative themes.

Results. Twenty-five of 26 LHDs (96% response rate) participated in our survey. Each LHD utilized a different approach to address the challenges they faced during their H1N1 vaccination campaign. Variation between LHDs was found in terms of the types of vaccine-dispensing methods implemented and in the selection of outside organizations LHDs partnered with to assist with vaccinations.

Conclusion. Having a Continuity of Operations Plan (COOP) and pandemic influenza plan, hiring temporary staff, building on existing community partnerships, implementing a variety of vaccination strategies and using a variety of sites are strategies that will help LHDs deal more effectively with challenges posed by future pandemics.


A method for estimating vaccine preventable pediatric influenza pneumonia hospitalizations in developing countries: Thailand as a case study
Dawood FS, Fry AM, Muangchana C et al. Vaccine. 13 April 2011; doi:10.1016/j.vaccine.2011.03.099
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-52M322G-8&_user=10&_coverDate=04%2F13%2F2011&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a47539171c8cb3df3b05f4829b32543f&searchtype=a

Abstract. The burden of influenza in children is increasingly appreciated; some middle-income countries are considering support for influenza vaccine programs. To support decision-making, methods to estimate the potential impact of proposed programs are needed. Using Thailand as a case-study, we present a model that uses surveillance data, published vaccine effectiveness estimates, and vaccination coverage assumptions to estimate the impact of influenza vaccination on pediatric influenza pneumonia hospitalizations. Approximately 56,000 influenza pneumonia hospitalizations occur annually among children aged <18 years in Thailand; 23,700 (41%) may be vaccine-preventable. Vaccination of 85% of Thai children aged 7 months–4 years might prevent 30% of all pediatric influenza pneumonia hospitalizations in Thailand.


Assessing secondary attack rates among household contacts at the beginning of the influenza A (H1N1) pandemic in Ontario, Canada, April-June 2009: A prospective, observational study.
Savage R, Whelan M, Johnson I et al. BMC Public Health. 14 April 2011; 11:23; doi:10.1186/1471-2458-11-234
Available at http://www.biomedcentral.com/1471-2458/11/234

Background. Understanding transmission dynamics of the pandemic influenza A (H1N1) virus in various exposure settings and determining whether transmissibility differed from seasonal influenza viruses was a priority for decision making on mitigation strategies at the beginning of the pandemic. The objective of this study was to estimate household secondary attack rates for pandemic influenza in a susceptible population where control measures had yet to be implemented.

Methods. All Ontario local health units were invited to participate; seven health units volunteered. For all laboratory-confirmed cases reported between April 24 and June 18, 2009, participating health units performed contact tracing to detect secondary cases among household contacts. In total, 87 cases and 266 household contacts were included in this study. Secondary cases were defined as any household member with new onset of acute respiratory illness (fever or two or more respiratory symptoms) or influenza-like illness (fever plus one additional respiratory symptom). Attack rates were estimated using both case definitions.

Results. Secondary attack rates were estimated at 10.3% (95% CI 6.8-14.7) for secondary cases with influenza-like illness and 20.2% (95% CI 15.4-25.6) for secondary cases with acute respiratory illness. For both case definitions, attack rates were significantly higher in children under 16 years than adults (25.4% and 42.4% compared to 7.6% and 17.2%). The median time between symptom onset in the primary case and the secondary case was estimated at 3.0 days.

Conclusions. Secondary attack rates for pandemic influenza A (H1N1) were comparable to seasonal influenza estimates suggesting similarities in transmission. High secondary attack rates in children provide additional support for increased susceptibility to infection.


Notes from the field: measles outbreak --- Hennepin County, Minnesota, February-March 2011
Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 8 April 2011; 60(13):421.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6013a6.htm

Abstract. On March 2, 2011, the Minnesota Department of Health (MDH) confirmed measles in a Hennepin County resident aged 9 months. As of April 1, investigation of contacts and heightened surveillance had revealed a total of 13 epidemiologically linked cases in Hennepin County residents. Of those cases, 11 were laboratory confirmed, and two were in household contacts of confirmed cases and met the clinical case definition for measles.


Measles imported by returning U.S. travelers aged 6-23 months, 2001-2011
Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 8 April 2011; 60(13):397-400.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6013a1.htm

Abstract. In the first 2 months of 2011, CDC received reports of seven imported measles cases among returning U.S. travelers aged 6--23 months; four required hospitalization. Young children are at greater risk for severe measles, death, or sequelae such as subacute sclerosing panencephalitis. Although all seven children had been eligible for vaccination before travel, none had received measles, mumps, and rubella (MMR) vaccine, the only measles-containing vaccine currently available in the United States. To characterize imported measles cases reported in the first 2 months of 2011 in U.S. travelers aged 6--23 months and compare them with cases in recent years, CDC analyzed data from the National Notifiable Diseases Surveillance System (NNDSS) for the period January 2001--February 2011. The results of that analysis indicated that, during January--February 2011, a total of 13 imported cases were reported in U.S. residents, including the seven children aged 6--23 months. During 2001--2010, a total of 159 imported cases were reported in U.S. residents, including 47 (range: 3--8 per year) in children aged 6--23 months (three of whom had been vaccinated before travel). Because measles remains endemic in much of the world, international travelers should be up-to-date on vaccinations. In accordance with the Advisory Committee for Immunization Practices (ACIP) recommendations, U.S. children who travel or live abroad should be vaccinated at an earlier age than those living in the United States because of the greater risk for exposure to measles outside the United States, and particularly outside the Americas.


How Climate Change May Make Killer Diseases Worse: Risk of Malaria, Other Diseases May Rise With Global Temperatures as Climate Changes
Halperin C. ABC News. 1 April 2011.
Available at http://abcnews.go.com/Politics/GlobalHealth/risk-malaria-diseases-rise-global-temperatures-climate/story?id=13277843
Abstract. Malaria already kills a million people a year and now, researchers fear, climate change could make the problem even worse. Working with the Kenya Meteorological Department, Madeleine Thomson, a senior research scientist for the International Research Institute for Climate and Society, has found that temperatures have increased significantly since the 1980s in the Kenyan Highlands. Thomson, who has been working in Africa for the past 25 years, has looked at the possibility of increased risk of malaria from a rise in global temperatures for the past ten.


5. Notifications
Keystone Symposia – Pathogenesis of Influenza: Virus-Host Interactions
Kowloon, Hong Kong, 23-28 May 2011
The mechanisms underlying the pathogenesis of influenza remain controversial. The current symposium brings together researchers working on the virus, viral receptors and tissue tropism, innate and adaptive immunity, systems biology and clinical aspects of lung injury and host defense, to address questions on the pathogenesis of influenza. The aim will be to integrate data from animal and ex vivo / in vitro human experimental models as well as human disease to understand pathogenesis of influenza and how this may lead to effective interventions. As this symposium will take place in the aftermath of the first pandemic in 40 years, there will be a wealth of new knowledge as well as intense scientific interest in the subject.
Additional information at http://www.keystonesymposia.org/meetings/viewMeetings.cfm?MeetingID=1127


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/


5th Ditan International Conference on Infectious Diseases
Beijing, China, 14-17 July 2011
Ditan International Conference on Infectious Diseases is the annual conference holding in Beijing to provide platform for scientific exchange between Chinese and international experts. It is co-organized by Beijing Ditan Hospital, European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Global Chinese Association of Clinical Microbiology and Infectious Diseases (GCACMID).
Additional information at http://www.bjditan.org/


Public Health Preparedness Capabilities: National Standards for State and Local Planning
The Centers for Disease Control and Prevention (CDC) released a set of standards for public health preparedness capabilities to help state and local public health agencies set priorities and strategies in an age of budget-cutting.
Additional information at http://www.cdc.gov/phpr/capabilities/


International Meeting on Emerging Diseases and Surveillance (IMED 2011) Presentations
Presentations from the IMED 2011 conference held in February 2011 are now available for download from the ISID website.
Additional information at http://imed.isid.org/symposia.shtml