Vol. XIV No. 9 ~ EINet News Briefs ~ Apr 29, 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: PAHO warns of H1N1 influenza spread in Americas region
- Global: Indonesia and Viet Nam find more H5N1 influenza in poultry
- Global: WHO group finalizes landmark pandemic virus-sharing agreement
- Bangladesh: Reports H5N1 influenza outbreaks at 30 more farms
- Cambodia: H5N1 avian influenza situation update
- Mongolia: H5 avian influenza found in whooper swans in Mongolia
- Viet Nam: Reports seven H5N1 avian influenza outbreaks
- USA: Company says FDA has approved its rapid influenza test
- Egypt: H5N1 avian influenza situation update

2. Infectious Disease News
- Global: Demand for dengue vaccine to exceed supply
- Australia (Queensland): Measles outbreak alert
- China (Beijing): Children suffering from scarlet fever to be quarantined at home
- China (Kunming): Severe hand-foot-and-mouth disease cases and deaths up from 2010
- Viet Nam: Reports of Rubella infection in northern Ha Giang province
- Chile: An outbreak of whooping cough (Pertussis)
- USA (Minnesota): Measles outbreak grows to 21 confirmed cases
- USA (Utah): Hundreds possibly exposed to measles at college events

3. Updates

4. Articles
- Epidemiology and Control of Clostridium difficile Infections in Healthcare Settings: An Update
- Rapid Assessment of Hib Disease Burden in Viet Nam
- Feasibility, Diagnostic accuracy, and Effectiveness of Decentralised Use of the Xpert MTB/RIF test for Diagnosis of Tuberculosis and Multidrug Resistance: A Multicentre Implementation Study
- Fever with Thrombocytopenia associated with a Novel Bunyavirus in China
- Toxoplasma gondii Infection in Workers Occupationally Exposed to Raw Meat
- Evolution of New Genotype of West Nile Virus in North America
- What the Public Was Saying about the H1N1 Vaccine: Perceptions and Issues Discussed in On-Line Comments during the 2009 H1N1 Pandemic
- Immunization-Safety Monitoring Systems for the 2009 H1N1 Monovalent Influenza Vaccination Program
- A Survey of Children's Preferences for Influenza Vaccine Attributes
- Influence Of Timing Of Seasonal Influenza Vaccination On Effectiveness And Cost-Effectiveness In Pregnancy
- Live Bird Markets of Bangladesh: H9N2 Viruses and the Near Absence of Highly Pathogenic H5N1 Influenza
- Predictors of the Uptake of A (H1N1) Influenza Vaccine: Findings from a Population-Based Longitudinal Study in Tokyo
- Challenges of Global Surveillance during an Influenza Pandemic
- Monitoring Influenza Activity in the United States: A Comparison of Traditional Surveillance Systems with Google Flu Trends

5. Notifications
- Keystone Symposia – Pathogenesis of Influenza: Virus-Host Interactions
- ISID-Neglected Tropical Diseases Meeting
- 5th Ditan International Conference on Infectious Diseases

1. Influenza News

2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Bangladesh / 2 (0)
Cambodia / 5 (5)
Egypt / 24 (7)
Indonesia / 5 (4)
Total / 36 (16)

***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: 552 (322) (WHO 4/21/2011)

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: PAHO warns of H1N1 influenza spread in Americas region
So far in 2011, some countries in the Americas region have reported 2009 H1N1 outbreaks that, though limited in scope, have placed a demand on local health services, the Pan American Health Organization (PAHO) said on 20 April 2011. Though the outbreaks aren't surprising, because the virus is now considered a seasonal strain, countries should still keep their guard up, the agency added. Outbreaks of the 2009 H1N1 influenza in 2011 have been reported in Ecuador, Mexico, and Venezuela, and as of April 2011 detections have increased in the Dominican Republic. PAHO said that, during the pandemic phase, the spread of the virus varied across the region. For example, circulation was intense in countries in the southernmost part of South America, with little detection over the winter of 2010. In some areas the proportion of the population that is still susceptible to the disease is high, which could lead to geographically limited sporadic outbreaks, the group said.
(CIDRAP 4/21/2011)


Global: Indonesia and Viet Nam find more H5N1 influenza in poultry
Indonesia and Viet Nam reported fresh H5N1 avian influenza outbreaks on 26 April 2011, as researchers who sampled birds in Bangladesh's live bird markets reported finding little of the virus, but a fair amount of H9N2 and other subtypes.

In a report to the World Organization for Animal Health (OIE), Indonesia's agriculture ministry detailed 18 outbreaks that were detected in villages in four districts of Gorontalo province from late March through early April.

OIE reports on Indonesian H5N1 outbreaks are rare, as they are for other countries where the H5N1 virus is endemic. However, Indonesian officials said that the Gorontalo outbreaks signify a recurrence of the disease, the first in the area since June 2007. The province is located on the northern part of Sulawesi Island.

The virus killed 817 birds in the villages, and 4,119 more were destroyed to curb the spread of the disease. Officials said the source of the virus was illegal movements of animals.

Meanwhile, Viet Nam's agriculture ministry said the virus struck a village in Vinh Long province, killing 1,050 birds and leading to the culling of 950 more to control the outbreak, according to the OIE. The province is located in the southern part of the country in the Mekong Delta. The source of the virus is unknown.
(CIDRAP 4/27/2011)


Global: WHO group finalizes landmark pandemic virus-sharing agreement
A World Health Organization (WHO) working group on influenza virus sharing capped off a week of negotiations with a final agreement that establishes a framework for sharing vaccine strains alongside a system for improving the flow of pandemic vaccine and medications to developing countries.

Controversy over the global sharing of influenza viruses, a key component of pandemic preparation, came to a head in 2006 when Indonesia, which has reported the most H5N1 avian influenza infections sand deaths, started withholding its virus samples as a protest against the high cost of commercial vaccines derived from such samples.

The unedited 43-page version of the agreement that the WHO shared on 18 April 2011 sets forth expectations for timely sharing of flu viruses such as H5N1 that have pandemic potential and requires that samples contain viable material and are accompanied by clinical and epidemiologic information needed for risk assessment.

The new agreement directs the WHO to establish a transparent electronic system to track the movement of virus samples in real time. It also includes two material transfer agreements, one covering viruses sent to WHO laboratories and one for other entities.

A benefit-sharing system included in the agreement presses member states to call upon their resources to provide pandemic surveillance and risk assessment, assist with capacity building efforts, and prioritize—on the basis of transparent guidelines—pandemic vaccines and antivirals for developing countries, especially the ones that are most affected and don't have the ability to produce or access countermeasures.

The agreement does not appear to include a payment to developing countries for the pandemic viruses they share, a suggestion floated during earlier negotiations by Indonesia's former health minister, Siti Fadilah Supari.

Several passages spell out the WHO's role in coordinating pandemic preparedness and response, such as making rapid risk assessments, providing technical assistance to countries to enhance surveillance capacity, and providing pandemic vaccine candidate viruses without preference and to any lab that asks, as long as they meet biosafety guidelines and use best biosafety practices.

The agreement calls on the WHO to work with other agencies and donors to develop a stockpile of antivirals and other equipment to contain pandemic outbreaks.

An initial stockpile of 150 million doses of H5N1 vaccine, contributed by vaccine companies and other donors, would include 50 million doses for affected countries, according to risk and need, to help stem the spread of the virus early in the outbreak. The other 100 million doses would be earmarked to help developing countries, once the pandemic begins, based on need and population size.

To oversee the agreement, the draft stipulates an oversight mechanism that includes an independent 18-member advisory group representing all WHO regions to monitor and ensure implementation.
(CIDRAP 4/18/2011)


Bangladesh: Reports H5N1 influenza outbreaks at 30 more farms
Bangladesh's livestock ministry reported on 21 April 2011 31 more H5N1 avian influenza outbreaks, according to the World Organization for Animal Health (OIE). The outbreaks occurred between the middle of March through mid-April, and all but one involved a commercial poultry farm. The outbreaks struck birds in five different provinces, with most of them occurring in Rajshahi, Dhaka, and Chittagong. The virus killed 26,543 poultry, and the remaining 153,888 birds at the affected sites were culled to curb the spread of the disease.
(CIDRAP 4/22/2011)


Cambodia: H5N1 avian influenza situation update
The Ministry of Health (MoH) of the Kingdom of Cambodia has announced a confirmed case of human infection with avian influenza A(H5N1) virus.

The case was a 5-year-old girl from Pea Raing district, Prey Veng Province. She developed symptoms on 11 April 2011, was initially treated by local private practitioners with no effect and was later admitted to Kantha Bopha Children Hospital on 13 April 2011. Despite all intensive care, she died on 16 April 2011, four days after admission.

There have been reports of poultry die off in her village. The girl is the fifteenth person in Cambodia to become infected with the H5N1 virus and the thirteenth to die from complications of the disease. All five cases of H5N1 infections in humans in Cambodia in 2011 have been fatal.

Specimens from 53 contacts of the cases were collected and are being tested by the National Institute for Public Health laboratory.
(WHO 4/21/2011)


Mongolia: H5 avian influenza found in whooper swans in Mongolia
Three whooper swans that were found dead on a lake in eastern Mongolia tested positive for an H5 avian influenza virus, according to the World Organization for Animal Health (OIE) on 20 April 2011. The swans were found at Zegst Lake in Sukhbaatar province. In other developments, a low-pathogenicity flu virus found in poultry in eastern Nebraska has been identified as an H7N9 subtype, a US Department of Agriculture official reported. The posting by Randall L. Levings said an H7N9 virus was isolated from geese and guinea fowl in a backyard flock. The virus's pathogenicity in chickens is being tested, he said.
(CIDRAP 4/20/2011)


Viet Nam: Reports seven H5N1 avian influenza outbreaks
Seven H5N1 avian influenza outbreaks occurred in poultry flocks in villages scattered among five provinces of Vietnam in late March and early April, the Vietnamese agriculture ministry on 18 April 2011. Officials said 5,509 of 6,932 susceptible birds got sick and 1,155 died, for an apparent case-fatality rate of 21%, well below what has been typical for outbreaks in Vietnam. Most of the rest of the birds were destroyed to stop the outbreaks. The outbreak start dates ranged from 28 March 2011 through 8 April 2011. Causes cited for the outbreaks included the introduction of new animals into flocks, illegal movement of animals, and fomites such as humans, vehicles, and feed. This was the fourth H5N1 outbreak filed by Vietnam in 2011.
(CIDRAP 4/19/2011)


USA: Company says FDA has approved its rapid influenza test
A diagnostic test that can identify and distinguish influenza A, influenza B, and the 2009 H1N1 flu virus in about an hour has been approved by the US Food and Drug Administration, according to the test's maker, Cepheid, based in Sunnyvale, Calif. The test, called Xpert Flu, runs on Cepheid's GenXpert System, the firm said on 26 April 2011. CEO John Bishop said, while molecular testing is widely recognized as the new gold standard for detection of influenza, it has generally been limited to highly complex laboratories. Xpert Flu empowers institutions with moderate complexity laboratories to have a molecular influenza test available to their physicians 24 hours a day.
(CIDRAP 4/26/2011)


Egypt: H5N1 avian influenza situation update
On 16 April 2011, the Ministry of Health of Egypt reported two new cases of human infection with avian influenza A (H5N1) virus.

The first case was a 29-year-old male from Fayoum Governorate Wadi Elrian area who developed symptoms on 1 April 2011, was hospitalized on 4 April 2011 and died on 7 April 2011.

The second case was a one-and-a-half-year-old male child from Fayoum Governorate, Sennores District who developed symptoms on 9 April 2011 and was hospitalized on 11 April 2011. He is under treatment and is in stable condition.

All the cases received oseltamivir treatment at the time of hospitalization.

Investigations into the source of infection indicate that both the cases had exposure to sick and/or dead poultry suspected to have avian influenza. There is no epidemiological link identified between these two cases.

The cases were confirmed by the Egyptian Central Public Health Laboratories, a National Influenza Center of the WHO Global Influenza Surveillance Network. Of the 143 cases confirmed as of 21 April 2011 in Egypt, 47 have been fatal.
(WHO 4/21/2011)


2. Infectious Disease News

Global: Demand for dengue vaccine to exceed supply
Decades in the making, the dengue vaccine's arrival is now in sight, but demand from the 2.5 billion people at risk of contracting this mosquito-borne disease will be much greater than the initial supply, health experts warn.

The vaccine is just around the corner, but the corner is four years from now stated Luiz Jacintho da Silva, director of the South Korea-based International Vaccine Institute (IVI). It is promising, but not an answer to all of our prayers.

While dengue vaccine development has been widespread among research institutions and pharmaceutical companies, Sanofi Pasteur, the largest vaccine developer in the world, is years ahead of the rest. If all goes well in the ongoing clinical trials, experts say immunizing the public may begin as soon as 2015. But the estimated 300 to 400 million people who will want the vaccine is too much for just one manufacturer.

Unless someone pops up with something fantastic, they will be the sole producer for a few years. Capacity will be limited and we will not be able to reach everyone said Da Silva. Forty years have gone into developing a dengue vaccine - three to four times longer than it took to create similar vaccines for other mosquito-borne illnesses such as Japanese encephalitis and yellow fever, said Steve Whitehead, a researcher with the Laboratory of Infectious Diseases, part of the US National Institutes of Health.

To be effective, four different dengue diseases had to be rolled into one vaccine, which made the process that much more complicated. It is clearly a difficult journey, said Joachim Hombach, acting head of the initiative of vaccine research for the World Health Organization (WHO) in Geneva.
(IRIN News 4/18/2011)


Australia (Queensland): Measles outbreak alert
Queensland appears headed for a bad measles season with 12 cases already identified in 2011, compared with 14 for the whole of 2010. Seven cases have been reported on the Gold Coast in 2011 in two separate outbreaks.

Queensland Health urged anyone attending Carindale Shopping Centre, in Brisbane's southeast, on 9 April 2011 to be alert to measles symptoms. The alert follows confirmation of a woman shopping there while infectious.
(ProMED 4/25/2011)


China (Beijing): Children suffering from scarlet fever to be quarantined at home
On 26 April 2011, Beijing announced scarlet fever surveillance and vaccination programs. Upon request, acute angina, scarlet fever should be isolated from patients with acute tonsillitis; seven days of close contacts should be under medical observation. During this period of medical observation, nurseries should not receive new children, transfer classroom care or change classes.

On 19 April 2011, Municipal Health Bureau released the report of the epidemic. In Beijing, 114 incidences reported scarlet fever. Municipal Health Bureau announced that Beijing is imposing a scarlet fever epidemic monitoring and disposal program (Trial). Subsequently, scarlet fever cases should be reported to the Communicable Disease Control Act.

Patients with scarlet fever should be treated in isolation at home for a period of seven days, avoiding contact with vulnerable populations. For nurseries, primary and secondary schools scarlet fever prevention and control has specific measures, stated the city health bureau official. Kindergartens, primary and secondary school teachers should install a daily morning inspection system, for fever, angina and tonsillitis. If suspected, teachers should persuade students to seek medical treatment as soon as possible.
(HealthMap 4/26/2011)


China (Kunming): Severe hand-foot-and-mouth disease cases and deaths up from 2010
For Kunming, the year 2011 has seen a high incidence of Hand-Foot-and-Mouth Disease. From February 2011, the number of cases in nurseries and primary schools has gradually increased. Severe cases and deaths from April 2010 to April 2011 have increased, in many cases the infections are EV71. The top five affected districts are Stone Forest, Songming, Jinning, Chenggong, Guand. Districts Panlong and Songming County have also had occasional outbreaks.
(HealthMap 4/27/2011)


Viet Nam: Reports of Rubella infection in northern Ha Giang province
Rubella infection has been reported in all 11 districts of the northern-most province of Ha Giang, with 286 cases confirmed, stated the province's general hospital on 25 April 2011. Most of the cases were among high school students.
(HealthMap 4/26/2011)


Chile: An outbreak of whooping cough (Pertussis)
An outbreak of whooping cough was recorded in Chile after cases of the disease reached 359 to the first week of April 2011, especially in the metropolitan area reported the Department of Epidemiology, Ministry of Health.

The ministry said the cumulative number of cases is higher than the average presented in the last five years, which are 205 for the same period. He explained that 60% of the cases correspond to less than a year, mostly infants less than six months.

It is serious, especially for infants less than six months, because it can cause complications such as bronchopneumonia, hypoglycemia, or seizures, said the expert Luis Barrueto, the Children's Respiratory Medicine Unit, University of Santiago.

Barrueto said that while all Chilean children are vaccinated against this disease, it happens that young children have not completed their scheduled vaccines they receive in the second, fourth and sixth month of life, at one and four years age. A child of three months, for obvious reasons, the vaccine can only be the second month, stated Barrueto.
(HealthMap 4/26/2011)


USA (Minnesota): Measles outbreak grows to 21 confirmed cases
More people have come down with measles. The Minnesota Department of Health is now reporting 21 confirmed cases of measles. 17 of the cases have been linked to a person who contracted the virus in Kenya. One case was contracted in Florida, and one in India. The infection source for one case is currently unknown.

Those who have come down with the measles range in age from 4-months to 51-years-old. In seven of the cases the person was too young to receive vaccine. Eight were old enough, but were not vaccinated. At least one was vaccinated. Health officials say it is unclear if the remaining four people have been vaccinated. 13 people have been hospitalized, but no deaths have been reported.
(ProMED 4/25/2011)


USA (Utah): Hundreds possibly exposed to measles at college events
Measles virus infection may have spread outside Salt Lake County, and public health officials are urging Utahans to get vaccinated earlier than usual. In an outbreak situation, we are encouraging people to get the second vaccine dose earlier, said Rebecca Ward, spokeswoman for the Utah Department of Health's communicable disease program.

As of 21 April 2011, all the state's nine confirmed cases had occurred in Salt Lake County. But because one of those patients attended two large events last week -- potentially exposing about 1,000 people -- the outbreak could spread beyond the county's borders.

Health Department spokeswoman Charla Haley said the person attended the events -- a presentation by author Nicholas Kristof at Salt Lake Community College in Salt Lake City on 11 April 2011 and the Entrepreneurial Challenge Final Awards Banquet at Rice-Eccles Stadium at the University of Utah on 13 April 2011 -- before knowing they had measles.

The State and the Salt Lake Valley health departments are seeking individuals who attended those events and who aren't naturally immune to the measles, or who hadn't received two doses of the vaccine against the virus. They want those people to quarantine themselves in their homes until the infectious period has passed: 29 April 2011 for the Kristof speech and 1 May 2011 for the University of Utah event.
(ProMED 4/25/2011)


3. Updates
Influenza A/H1N1: http://www.who.int/csr/disease/swineflu/en/index.html
Influenza A/H1N1 frequently asked questions:
Pandemic Influenza Preparedness and Response - A WHO Guidance Document
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:
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:
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.


China (Beijing)
A total of 11 Chinese people, aged between 20 to 50, died from malignant malaria from January to March 2011, according to the Ministry of Health on 18 April 2011.

According to the statement, the number of malaria cases had plunged from an annual average of 30 million when the People's Republic of China was founded in 1,949 to 7,433 cases in 2010. However, recent years had witnessed rising deaths from malignant malaria, due to greater population flow.

The Ministry of Health, together with other related government departments, will carry out a publicity campaign to raise awareness of malaria prevention and control in the lead-up to the national malaria day which falls on 26 April 2011.
(ProMED 4/20/2011)

Chinese Taipei
On 26 April 2011, The Centers for Disease Control (CDC) under the Department of Health confirmed the first case of encephalitis caused by Acanthamoeba spp. in Taiwan.

The patient is a 63-year-old male in central Taiwan. The previously healthy farmer fell into a ditch during farm work in a rice field in December 2008, said Chi Te-te, a CDC researcher. He later displayed symptoms such as a high fever, severe headaches and abdominal distention 10 days after the accident. He was then sent to a hospital in central Taiwan's Changhwa County for treatment, said Chi.

His cerebrospinal fluid test revealed a high number of white blood cells which could indicate a parasite infection. A further test showed that the farmer was infected by Acanthamoeba spp, which are free-living amoebae that inhabit a variety of air, soil, and water environments. Ditch water specimens also found identical Acanthamoeba spp.

The patient was later transferred to National Taiwan University Hospital in Taipei for further treatment after being diagnosed with the rare disease. It took him 78 days before his full recovery, said Chi. However, the patient has developed some side effects since his recovery, such as problems with speech.The mortality rate associated with Acanthamoeba infection is very high at around 80 to 90%. It is therefore rare that a local hospital was able to help the patient recover, according to the CDC.
(HealthMap 4/27/2011)

Thailand (Yala)
More than 2,000 people in Thailand were infected with malaria between January and April 2011, the Public Health Ministry said on 21 April 2011.

Malaria remains a threat in the deep south, especially Yala Province, where the number of malaria cases has increased from 30 a year to 3,000 annually over the past several years because of the unrest in the area, Vector-Borne Disease Bureau director Dr. Wichai Satimai said.

Medical personnel could not enter villages to provide medicine and equipment to prevent infection, because of the unrest during the past few years, he said. He was speaking at a workshop on malaria prevention and control for high-risk groups living along Thailand's borders.

He said the number of Thais diagnosed with malaria from January to March was 2,320. But when compared with the same period in 2010, the figure had decreased 44%. Meanwhile, the number of foreigners infected with malaria in Thailand in 2011 was 3,220, a 19% decrease from the same period in 2010. IN 2010, about 24,816 people were infected with malaria. Of this number, about 15,181 cases were people living along the Thailand-Burma border.

Dr. Charles Delacollette, manager of the World Health Organization's Mekong Malaria Programme, said he was worried about the spread of infection along the Thai-Burmese border, as the number of malaria cases in Burma had increased to more than 400,000 in 2009. If there is no collaboration between Thailand and Burma, they are going to fail in disease prevention, he said. However, there is a declining interest among government and donors in malaria control and prevention.

Wichai said reductions to public health staff nationwide due to reorganization of the health system and poor community participation and involvement had led to inadequate public awareness of the malaria problem. Inflexibility in the malaria surveillance system, which is unable to respond to changing situations, is another obstacle to controlling the disease, he said.
(ProMED 4/22/2011)


Chinese Taipei
The Centers for Disease Control (CDC) of Taiwan confirmed on 15 April 2011 the first imported case of cholera of 2011 and advised the public to take extra precautions when traveling to Southeast Asian countries with a high prevalence of the disease.

A 29-year-old resident of southern Taiwan was suspected of having contracted cholera after experiencing painless diarrhea and vomiting upon her return from a four day trip to Sabah, Malaysia. The health authorities said grilled fish and shrimp she ate on a local beach could have been the cause of transmission. She sought medical help on 1 April 2011, a day after her return, and was confirmed to be suffering from cholera on 12 April 2011, according to the CDC.

The patient recovered, said CDC director-general Chou Jih-haw, who added that her travel companions and two relatives living with her did not present any symptoms.
(ProMED 4/19/2011)

Malaysia (Sabah)
The cholera control operations room for Penampang and Putatan, near Kota Kinabalu in Sabah state, has been activated following reports of two cholera cases there early the week of 11 April 2011, Sabah deputy chief minister Datuk Yahya Hussin said.

He said one of the cases was reported at a "kongsi" house of a construction project in Putatan and the other at Kampung Duvanson. I have been informed by the Penampang health officer, Dr Mohd Saffree Jeffree, that his office has activated the cholera control operations room to facilitate measures to curb spread of the disease.
(ProMED 4/19/2011)

Papua New Guinea
Health officials in Papua New Guinea’s New Ireland province are advising people to take precautions to ensure there’s no spread of cholera in the province.

Cholera has affected half of PNG’s provinces over the past two years with more than 600 deaths, with New Ireland recording its first case in March 2011.

Alphonse Wena of the cholera prevention task force says the only recorded case was at the Lihir gold mine and they hope their measures will ensure no more occurrences. We have a ban on fast food (street sellers) and have advised people on the preventive measures of washing their hands, washing food and boiling water - basically personal hygiene measures and we have advised people to restrict unnecessary movements to and fro.
(HealthMap 4/26/2011)

Philippines (Palawan)
There was no potable water, no toilets. The tribesmen defecated everywhere, and used contaminated water to both wash and as a source of drinking water said Manuel Mapue, who headed a government medical mission dispatched to the area.

At least 20 people have died and hundreds more have become sick, the country's National Disaster Risk Reduction and Management Council (NDRRMC) reported on 20 April 2011. 17 of the 22 villages in the town of Bataraza on Palawan island were affected by the outbreak, which began in March 2011 and slowly progressed, affecting more than 500 people, the report said. 21 people died from diarrhea in the nearby village of Rizal, although officials say it was too early to suggest the cases were connected, the local Red Cross said.

A lack of clean drinking water and proper sanitation facilities and toilets all contributed to the spread of the disease. The first few who died were also buried near the main river system, contaminating the main source of water.

Those affected were members of the Palawan ethnic group, cave-dwellers in the remote jungles of Bataraza, who live off the land. Their location was so remote it was only accessible after a four-hour walk from the nearest village that had access to any semblance of rudimentary health facilities, officials said. The NDRRMC in Manila said the medical team had set up a temporary field hospital near the area, and distributed medicine to stem the disease's spread. We are closely monitoring the situation, and for the time being, the local authorities in cooperation with Department of Health Officials are handling the situation stated Abigail Valte, a spokeswoman for President Benigno Aquino.
(IRIN News 4/21/2011)


4. Articles
Epidemiology and Control of Clostridium difficile Infections in Healthcare Settings: An Update
Barbut F, Jones G, Eckert C. Curr Opin Infect Dis. 20 April 2011. doi: 10.1097/QCO.0b013e32834748e5
Available at http://www.ncbi.nlm.nih.gov/pubmed/21505332

Purpose of Review. The epidemiology of Clostridium difficile infections (CDIs) has dramatically changed over the last decade in both North America and Europe. The objectives of this review are to highlight the recent epidemiological data and to provide an overview of the current knowledge of infection control measures.

Recent Findings. Since 2003, many countries have reported increased incidence of CDI and outbreaks of severe cases of CDI. This trend is assumed to be due, in part, to the emergence and rapid spread of a 'hypervirulent' strain, known as 027/BI/NAP1. This strain has become endemic in many hospitals in North America and Europe. CDI rates have also increased in the community and new genotypes (e.g. PCR ribotype 078) are emerging in both humans and animals. To prevent cross-contamination and to reduce the incidence of CDI, infection control guidelines, based primarily on experience of hospitals during outbreaks, have been recently updated in Europe and the United States. CDI prevention relies on a bundle of measures including antimicrobial stewardship, prompt diagnosis, and the implementation of contact precautions. Currently, most of these measures have appeared effective in controlling outbreaks, but the best methods to reduce CDI incidence in settings of endemicity are still unknown.


Rapid Assessment of Hib Disease Burden in Viet Nam
Nyambat B, Dang DA, Nguyen HA et al. BMC Public Health. 25 April 2011. 11(1):260. doi:10.1186/1471-2458-11-260
Available at http://www.biomedcentral.com/1471-2458/11/260

Background. Several countries have applied the Haemophilus influenza type b (Hib) rapid assessment tool (RAT) to estimate the burden of Hib disease where resources for hospital- or population-based surveillance are limited. In Vietnam, we used the Hib RAT to estimate the burden of Hib pneumonia and meningitis prior to Hib vaccine introduction.

Methods. Laboratory, hospitalization and mortality data were collected for the period January 2004 through December 2005 from five representative hospitals. Based on the WHO Hib RAT protocol, standardized MS Excel spreadsheets were completed to generate meningitis and pneumonia case and death figures.

Results. We found 35 to 77 Hib meningitis deaths and 441 to 957 Hib pneumonia deaths among children <5 years of age annually in Vietnam. Overall, the incidence of Hib meningitis was estimated at 18/100,000 (95% confidence interval, CI, 15.1-21.6). The estimated Hib meningitis incidence in children <5 years age was higher in Ho Chi Minh City (22.5/100,000 [95% CI, 18.4-27.5]) compared to Hanoi (9.8/100,000 [95% CI, 6.5-14.8]). The Hib RAT suggests that there are a total of 883 to 1,915 cases of Hib meningitis and 4,414 to 9,574 cases of Hib pneumonia per year in Vietnam.

Conclusions. In Hanoi, the estimated incidence of Hib meningitis for children <5 years of age was similar to that described in previous population-based studies of Hib meningitis conducted from 1999 through 2002. Results from the Hib RAT suggest that there is a substantial, yet unmeasured, disease burden associated with Hib pneumonia in Vietnamese children.


Feasibility, Diagnostic accuracy, and Effectiveness of Decentralised Use of the Xpert MTB/RIF test for Diagnosis of Tuberculosis and Multidrug Resistance: A Multicentre Implementation Study
Boehme CC, Nicol MP, Nabeta P et al. Lancet. 18 April 2011. doi:10.1016/S0140-6736(11)60438-8
Available at http://www.ncbi.nlm.nih.gov/pubmed/21507477

Background. The Xpert MTB/RIF test (Cepheid, Sunnyvale, CA, USA) can detect tuberculosis and its multidrug-resistant form with very high sensitivity and specificity in controlled studies, but no performance data exist from district and subdistrict health facilities in tuberculosis-endemic countries. We aimed to assess operational feasibility, accuracy, and effectiveness of implementation in such settings.

Methods. We assessed adults (≥18 years) with suspected tuberculosis or multidrug-resistant tuberculosis consecutively presenting with cough lasting at least 2 weeks to urban health centres in South Africa, Peru, and India, drug-resistance screening facilities in Azerbaijan and the Philippines, and an emergency room in Uganda. Patients were excluded from the main analyses if their second sputum sample was collected more than 1 week after the first sample, or if no valid reference standard or MTB/RIF test was available. We compared one-off direct MTB/RIF testing in nine microscopy laboratories adjacent to study sites with 2-3 sputum smears and 1-3 cultures, dependent on site, and drug-susceptibility testing. We assessed indicators of robustness including indeterminate rate and between-site performance, and compared time to detection, reporting, and treatment, and patient dropouts for the techniques used.

Findings. We enrolled 6648 participants between Aug 11, 2009, and June 26, 2010. One-off MTB/RIF testing detected 933 (90•3%) of 1033 culture-confirmed cases of tuberculosis, compared with 699 (67•1%) of 1041 for microscopy. MTB/RIF test sensitivity was 76•9% in smear-negative, culture-positive patients (296 of 385 samples), and 99•0% specific (2846 of 2876 non-tuberculosis samples). MTB/RIF test sensitivity for rifampicin resistance was 94•4% (236 of 250) and specificity was 98•3% (796 of 810). Unlike microscopy, MTB/RIF test sensitivity was not significantly lower in patients with HIV co-infection. Median time to detection of tuberculosis for the MTB/RIF test was 0 days (IQR 0-1), compared with 1 day (0-1) for microscopy, 30 days (23-43) for solid culture, and 16 days (13-21) for liquid culture. Median time to detection of resistance was 20 days (10-26) for line-probe assay and 106 days (30-124) for conventional drug-susceptibility testing. Use of the MTB/RIF test reduced median time to treatment for smear-negative tuberculosis from 56 days (39-81) to 5 days (2-8). The indeterminate rate of MTB/RIF testing was 2•4% (126 of 5321 samples) compared with 4•6% (441 of 9690) for cultures.

Interpretation. The MTB/RIF test can effectively be used in low-resource settings to simplify patients' access to early and accurate diagnosis, thereby potentially decreasing morbidity associated with diagnostic delay, dropout and mistreatment.


Fever with Thrombocytopenia associated with a Novel Bunyavirus in China
Yu XJ, Liang MF, Zhang SY et al. N Engl J Med. 21 April 2011. 364(16):1523-32.
Available at http://www.nejm.org/doi/full/10.1056/NEJMoa1010095

Background. Heightened surveillance of acute febrile illness in China since 2009 has led to the identification of a severe fever with thrombocytopenia syndrome (SFTS) with an unknown cause. Infection with Anaplasma phagocytophilum has been suggested as a cause, but the pathogen has not been detected in most patients on laboratory testing.

Methods. We obtained blood samples from patients with the case definition of SFTS in six provinces in China. The blood samples were used to isolate the causal pathogen by inoculation of cell culture and for detection of viral RNA on polymerase-chain-reaction assay. The pathogen was characterized on electron microscopy and nucleic acid sequencing. We used enzyme-linked immunosorbent assay, indirect immunofluorescence assay, and neutralization testing to analyze the level of virus-specific antibody in patients' serum samples.

Results. We isolated a novel virus, designated SFTS bunyavirus, from patients who presented with fever, thrombocytopenia, leukocytopenia, and multiorgan dysfunction. RNA sequence analysis revealed that the virus was a newly identified member of the genus phlebovirus in the Bunyaviridae family. Electron-microscopical examination revealed virions with the morphologic characteristics of a bunyavirus. The presence of the virus was confirmed in 171 patients with SFTS from six provinces by detection of viral RNA, specific antibodies to the virus in blood, or both. Serologic assays showed a virus-specific immune response in all 35 pairs of serum samples collected from patients during the acute and convalescent phases of the illness.

Conclusions. A novel phlebovirus was identified in patients with a life-threatening illness associated with fever and thrombocytopenia in China.


Toxoplasma gondii Infection in Workers Occupationally Exposed to Raw Meat
Alvarado-Esquivel C, Liesenfeld O, Estrada-Martínez S et al. Occup Med (Lond). doi: 10.1093/occmed/kqr032
Available at http://occmed.oxfordjournals.org/content/early/2011/04/21/occmed.kqr032.long

Background. Raw meat may contain viable Toxoplasma gondii tissue cysts and therefore handling of raw meat may represent a risk for T. gondii infection.

Aims. To determine the association of T. gondii infection with occupational exposure to raw meat.

Methods. Case-control seroprevalence study design with enzyme-linked immunoassays for the presence and levels of anti-Toxoplasma IgG antibodies and for the presence of anti-Toxoplasma IgM antibodies. Those occupationally exposed to raw meat consisted of butchers working in two abattoirs and 35 butcher's shops in Durango, Mexico. The control group consisted of individuals from the general population from the same region. Socio-demographic, work, clinical and behavioural characteristics from each butcher were obtained.

Results. One hundred and twenty-four workers occupationally exposed to raw meat and 248 control subjects were examined. Eight (7%) of the butchers and 22 (9%) of the controls were positive for anti-T. gondii IgG antibodies [not statistically significant (NS)]. Anti-T. gondii IgG levels were >150 IU/ml in 7 (6%) butchers and 14 (6%) controls (NS). Anti-T. gondii IgM antibodies were found in five (4%) of the butchers and four (2%) of the controls (NS). None of the factors examined appeared to predict seropositivity although both butchers who reported consuming dried beef were seropositive compared to 6/122 controls (95% CI 0.60-1.29).

Conclusions. Occupational exposure to raw meat was not associated with seropositivity for T. gondii infection. Consumption of dried beef may warrant further investigation.


Evolution of New Genotype of West Nile Virus in North America
McMullen AR, May FJ, Li L et al. Emerg Infect Dis. 21 April 2011. 17(5):785-93. doi: 10.3201/eid1705.101707
Available at http://www.cdc.gov/eid/content/17/5/785.htm#cit

Abstract. Previous studies of North American isolates of West Nile virus (WNV) during 1999–2005 suggested that the virus had reached genetic homeostasis in North America. However, genomic sequencing of WNV isolates from Harris County, Texas, during 2002–2009 suggests that this is not the case. Three new genetic groups have been identified in Texas since 2005. Spread of the southwestern US genotype (SW/WN03) from the Arizona/Colorado/northern Mexico region to California, Illinois, New Mexico, New York, North Dakota, and the Texas Gulf Coast demonstrates continued evolution of WNV. Thus, WNV continues to evolve in North America, as demonstrated by selection of this new genotype. Continued surveillance of the virus is essential as it continues to evolve in the New World.


What the Public Was Saying about the H1N1 Vaccine: Perceptions and Issues Discussed in On-Line Comments during the 2009 H1N1 Pandemic
Henrich N, Holmes B. PLoS ONE. 18 April 2011. 6(4): e18479. doi:10.1371/journal.pone.0018479
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0018479

Abstract. During the 2009 H1N1 pandemic, a vaccine was made available to all Canadians. Despite efforts to promote vaccination, the public's intent to vaccinate remained low. In order to better understand the public's resistance to getting vaccinated, this study addressed factors that influenced the public's decision making about uptake. To do this, we used a relatively novel source of qualitative data – comments posted on-line in response to news articles on a particular topic. This study analysed 1,796 comments posted in response to 12 articles dealing with H1N1 vaccine on websites of three major Canadian news sources. Articles were selected based on topic and number of comments. A second objective was to assess the extent to which on-line comments can be used as a reliable data source to capture public attitudes during a health crisis. The following seven themes were mentioned in at least 5% of the comments (% indicates the percentage of comments that included the theme): fear of H1N1 (18.8%); responsibility of media (17.8%); government competency (17.7%); government trustworthiness (10.7%); fear of H1N1 vaccine (8.1%); pharmaceutical companies (7.6%); and personal protective measures (5.8%). It is assumed that the more frequently a theme was mentioned, the more that theme influenced decision making about vaccination. These key themes for the public were often not aligned with the issues and information officials perceived, and conveyed, as relevant in the decision making process. The main themes from the comments were consistent with results from surveys and focus groups addressing similar issues, which suggest that on-line comments do provide a reliable source of qualitative data on attitudes and perceptions of issues that emerge in a health crisis. The insights derived from the comments can contribute to improved communication and policy decisions about vaccination in health crises that incorporate the public's views.


Immunization-Safety Monitoring Systems for the 2009 H1N1 Monovalent Influenza Vaccination Program
Salmon DA, Akhtar A, Mergler MJ et al. Pediatrics.18 April 2011. doi:10.1542/peds.2010-1722L
Available at http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-1722Lv1

Abstract. The effort to vaccinate the US population against the 2009 H1N1 influenza virus hinged, in part, on public confidence in vaccine safety. Early in the vaccine program, >20% of parents reported that they would not vaccinate their children. Concerns about the safety of the vaccines were reported by many parents as a factor that contributed to their intention to forgo vaccination. The safety profiles of 2009 H1N1 monovalent influenza vaccines were anticipated to be (and have been) similar to those of seasonal influenza vaccines, for which an excellent safety profile has been demonstrated. Here we describe steps taken by the US government to (1) assess the key federal systems in place before 2009 for monitoring the safety of vaccines and (2) integrate and upgrade those systems for optimal vaccine-safety monitoring during the 2009 H1N1 monovalent influenza vaccination program. These efforts improved monitoring of 2009 H1N1 vaccine safety, hold promise for enhancing future national monitoring of vaccine safety, and may ultimately help improve public confidence in vaccines.


A Survey of Children's Preferences for Influenza Vaccine Attributes
Flood EM, Ryan KJ, Rousculp MD et al. Vaccine. 19 April 2011. doi:10.1016/j.vaccine.2011.04.018
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD4-52NCKH7-4&_user=10&_coverDate=04%2F19%2F2011&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=cf537854dd1b7d2d68be7288b5579994&searchtype=a

Background. While annual influenza vaccination is recommended by the CDC for children 6 months and older, vaccination rates remain suboptimal. For healthy, US children 2 years of age and older, influenza vaccine is available as an intramuscular injection (TIV) or an intranasal spray (LAIV), respectively. Little is known about children's experiences and preferences for influenza vaccine attributes.

Objective. To examine preferences for influenza vaccine attributes and their relative importance among children.

Methods. A quantitative web-survey was administered to children aged 8–12 years sampled from a standing online panel representative of the US population. Children were stratified by age, gender and parent's influenza vaccination behavior. The survey included questions to ascertain children's preferences for influenza vaccine attributes, including efficacy, chance of common side effects, and mode of administration. It included conjoint (trade-off) questions in which children traded-off different attributes in their choice between two influenza vaccines with differing features. We also surveyed children's comprehension of and ability to complete the conjoint questions.

Results. 544 children completed the survey (response rate 37%). Children most frequently selected efficacy as the most important vaccine attribute followed by mode of administration (45% and 31%, respectively). When asked for their preference to receive influenza vaccine as a “shot” or a “nose spray”, the majority (69%) preferred the nose spray. An evaluation of children's ability to complete the conjoint survey demonstrated that 85% of the sample was able to complete the conjoint tasks. Analysis of the conjoint responses demonstrated that mode of administration and efficacy had the greatest impact on preferences, with a relative importance of 40.5% and 30.6%, respectively. In a direct comparison of vaccine profiles representing the efficacy, side effects, and other characteristics of LAIV and TIV, 79% of children preferred the LAIV-like profile.

Conclusion. Children in the sample had consistent opinions regarding influenza vaccine attributes and consider vaccine efficacy and mode of administration to be important. Children can be informed participants in influenza prevention and can be included in discussions regarding influenza vaccination.


Influence Of Timing Of Seasonal Influenza Vaccination On Effectiveness And Cost-Effectiveness In Pregnancy
Myers ER, Misurski DA, Swamy GK. Am J Obstet Gynecol. 18 April 2011. doi:10.1016/j.ajog.2011.04.009
Available at http://www.ajog.org/article/S0002-9378%2811%2900455-8/abstract

Objective. To estimate the impact of timing of seasonal influenza vaccination during pregnancy on health and economic outcomes.

Study Design. Cost-effectiveness analysis using a dynamic model of the US population of pregnant women and infants younger than 6 months, incorporating seasonal variation in influenza incidence.

Results. Compared to no vaccination, seasonal influenza vaccination in pregnancy costs $70,089 per quality-adjusted life year. The majority of benefit for infants was limited to those whose mothers were vaccinated within the first 4 weeks of vaccine availability. Once all women pregnant at the time of vaccine availability are vaccinated, vaccination of newly pregnant women has benefits for mothers but not infants. Delaying vaccination beyond November reduced both effectiveness and cost-effectiveness.

Conclusions. The greatest population benefit from seasonal influenza vaccination in pregnancy is realized if pregnant women are vaccinated as soon as possible after TIV becomes available. Efforts to increase vaccine rates should be concentrated early in the influenza season.


Live Bird Markets of Bangladesh: H9N2 Viruses and the Near Absence of Highly Pathogenic H5N1 Influenza
Negovetich NJ, Feeroz MM, Jones-Engel L et al. PLoS ONE. 26 April 2011. 6(4): e19311. doi:10.1371/journal.pone.0019311
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0019311

Abstract. Avian influenza surveillance in Bangladesh has been passive, relying on poultry farmers to report suspected outbreaks of highly pathogenic H5N1 influenza. Here, the results of an active surveillance effort focusing on the live-bird markets are presented. Prevalence of influenza infection in the birds of the live bird markets is 23.0%, which is similar to that in poultry markets in other countries. Nearly all of the isolates (94%) were of the non-pathogenic H9N2 subtype, but viruses of the H1N2, H1N3, H3N6, H4N2, H5N1, and H10N7 subtypes were also observed. The highly pathogenic H5N1-subtype virus was observed at extremely low prevalence in the surveillance samples (0.08%), and we suggest that the current risk of infection for humans in the retail poultry markets in Bangladesh is negligible. However, the high prevalence of the H9 subtype and its potential for interaction with the highly pathogenic H5N1-subtype, i.e., reassortment and attenuation of host morbidity, highlight the importance of active surveillance of the poultry markets.


Predictors of the Uptake of A (H1N1) Influenza Vaccine: Findings from a Population-Based Longitudinal Study in Tokyo
Yi S, Nonaka D, Nomoto M, Kobayashi J et al. PLoS ONE. 27 April 2011. 6(4): e18893. doi:10.1371/journal.pone.0018893
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0018893

Background. Overall pandemic A (H1N1) influenza vaccination rates remain low across all nations, including Japan. To increase the rates, it is important to understand the motives and barriers for the acceptance of the vaccine. We conducted this study to determine potential predictors of the uptake of A (H1N1) influenza vaccine in a cohort of Japanese general population.

Methodology/Principal Findings. By using self-administered questionnaires, this population-based longitudinal study was conducted from October 2009 to April 2010 among 428 adults aged 18–65 years randomly selected from each household residing in four wards and one city in Tokyo. Multiple logistic regression analyses were performed. Of total, 38.1% of participants received seasonal influenza vaccine during the preceding season, 57.0% had willingness to accept A (H1N1) influenza vaccine at baseline, and 12.1% had received A (H1N1) influenza vaccine by the time of follow-up. After adjustment for potential confounding variables, people who had been vaccinated were significantly more likely to be living with an underlying disease (p = 0.001), to perceive high susceptibility to influenza (p = 0.03), to have willingness to pay even if the vaccine costs ≥ US$44 (p = 0.04), to have received seasonal influenza vaccine during the preceding season (p<0.001), and to have willingness to accept A (H1N1) influenza vaccine at baseline (p<0.001) compared to those who had not been vaccinated.

Conclusions/Significance. While studies have reported high rates of willingness to receive A (H1N1) influenza vaccine, these rates may not transpire in the actual practices. The uptake of the vaccine may be determined by several potential factors such as perceived susceptibility to influenza and sensitivity to vaccination cost in general population.


Challenges of Global Surveillance during an Influenza Pandemic
Briand S, Mounts A, Chamberland M. Public Health. 27 April 2011. doi:10.1016/j.puhe.2010.12.007
Available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B73H6-52R7MXH-1&_user=10&_coverDate=04%2F27%2F2011&_rdoc=1&_fmt=high&_orig=gateway&_origin=gateway&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ad1bc00bf8079f93960506400bfc56b6&searchtype=a

Abstract. Surveillance is an essential foundation for monitoring and evaluating any disease process, and is especially critical when new disease agents appear. The H1N1 influenza pandemic of 2009 tested the capacities of countries to detect, assess, notify and report events as required by the 2005 International Health Regulations (IHR). As detailed in the IHR, the World Health Organization drew on official reports from Member States as well as unofficial sources (e.g. media alerts) to quickly report and disseminate information about the appearance of the novel influenza virus. The pre-existing Global Influenza Surveillance Network for virological surveillance also provided crucial information for rapid development of a vaccine and for detection of changes in the virus. However, the pandemic also highlighted a number of shortcomings in global epidemiological surveillance for respiratory disease. These included the lack of standards for reporting illness, risk factor and mortality data, and a mechanism for systematic reporting of epidemiological data. Such measures would have facilitated direct comparison of data between countries and improved timely understanding of the characteristics and impact of the pandemic. This paper describes the surveillance strategies in place before the pandemic and the methods that were used at global level to monitor the pandemic. Enhancements of global surveillance are proposed to improve preparedness and response for similar events in the future.


Monitoring Influenza Activity in the United States: A Comparison of Traditional Surveillance Systems with Google Flu Trends
Ortiz JR, Zhou H, Shay DK et al. PLoS ONE. 27 April 2011. 6(4): e18687. doi:10.1371/journal.pone.0018687
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0018687

Background. Google Flu Trends was developed to estimate US influenza-like illness (ILI) rates from internet searches; however ILI does not necessarily correlate with actual influenza virus infections.

Methods and Findings. Influenza activity data from 2003–04 through 2007–08 were obtained from three US surveillance systems: Google Flu Trends, CDC Outpatient ILI Surveillance Network (CDC ILI Surveillance), and US Influenza Virologic Surveillance System (CDC Virus Surveillance). Pearson's correlation coefficients with 95% confidence intervals (95% CI) were calculated to compare surveillance data. An analysis was performed to investigate outlier observations and determine the extent to which they affected the correlations between surveillance data. Pearson's correlation coefficient describing Google Flu Trends and CDC Virus Surveillance over the study period was 0.72 (95% CI: 0.64, 0.79). The correlation between CDC ILI Surveillance and CDC Virus Surveillance over the same period was 0.85 (95% CI: 0.81, 0.89). Most of the outlier observations in both comparisons were from the 2003–04 influenza season. Exclusion of the outlier observations did not substantially improve the correlation between Google Flu Trends and CDC Virus Surveillance (0.82; 95% CI: 0.76, 0.87) or CDC ILI Surveillance and CDC Virus Surveillance (0.86; 95%CI: 0.82, 0.90).

Conclusions. This analysis demonstrates that while Google Flu Trends is highly correlated with rates of ILI, it has a lower correlation with surveillance for laboratory-confirmed influenza. Most of the outlier observations occurred during the 2003–04 influenza season that was characterized by early and intense influenza activity, which potentially altered health care seeking behavior, physician testing practices, and internet search behavior.


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/