Vol. XIV No. 11 ~ EINet News Briefs ~ May 27, 2011

*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:

1. Influenza News
- 2011 Cumulative number of human cases of avian influenza A/H5N1
- Global: Influenza situation stays sedate, locally and globally
- Global: WHA passes pandemic review, tweaks virus-sharing framework
- UK: More H1N1 pandemic influenza deaths in winter 2011 than during pandemic
- New Zealand: Waikato tops influenza case numbers
- South Korea: H5N1 avian influenza outbreak in egg farm
- Viet Nam: Four H5N1 avian influenza outbreaks reported
- South Africa: H5N2 avian influenza hits commercial ostrich farms

2. Infectious Disease News
- Global: U.S. part of growing spread of global measles outbreak
- Australia: Medical tourism boom raises superbug risk
- Australia: Murray Valley encephalitis in a returning Canadian traveller
- Hong Kong: Nursery school with hand, foot and mouth disease outbreak
- Indonesia (Bali): German tourist diagnosed with Japanese encephalitis
- New Zealand: Possible cases of Legionella identified
- Russia: Tick-borne encephalitis contracted by consumption of goat milk
- Russia: Crimean-Congo hemorrhagic fever
- Russia: Rabid dogs bite 12 inhabitants of Moscow suburbs
- Viet Nam: City hospital reports another pig bacterium case
- Chile (Biobio): Sixth confirmed case of hantavirus in 2011
- Chile (Maule): New case of hantavirus infection
- USA (Maine): Rodent-borne virus makes first appearance
- USA (California): Local health officials confirm case of measles in San Luis Obispo County
- USA (Massachusetts): Two more confirmed cases of measles
- USA (New York): Student confirmed to have measles

3. Updates

4. Articles
- The Usefulness of Case Reports in Managing Emerging Infectious Disease
- Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review
- Knowledge, Attitudes and Practices KAP related to the Pandemic (H1N1) 2009 among Chinese General Population: a Telephone Survey
- A Postmarketing Evaluation of the Frequency of Use and Safety of Live Attenuated Influenza Vaccine use in Nonrecommended Children Younger than 5 years
- Characterizing the Epidemiology of the 2009 Influenza A/H1N1 Pandemic in Mexico.
- Racial and Ethnic Disparities in Uptake and Location of Vaccination for 2009-H1N1 and Seasonal Influenza
- Circulating Influenza Virus, Climatic Factors, and Acute Myocardial Infarction: A Time Series Study in England and Wales and Hong Kong
- Trends in Malaria Research in 11 Asian Pacific Countries: An Analysis of Peer-Reviewed Publications over Two Decades
- Measles --- United States, January--May 20, 2011

5. Notifications
- ISID-Neglected Tropical Diseases Meeting
- 5th Ditan International Conference on Infectious Diseases
- Conference on Crisis Management in the Food Chain: presentations available online

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 / 6 (5)
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: 553 (323) (WHO 5/13/2011)

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: Influenza situation stays sedate, locally and globally
Flu indicators fell again in the United States last week as the 2010-11 flu season approaches its end, with very little activity occurring elsewhere in the world, US and global surveillance organizations stated on 20 May 2011. All levels were below baseline, even the percentage of deaths from pneumonia and flu, which has lagged the decline of other flu signals, the US Centers for Disease Control and Prevention (CDC) stated 20 May 2011.

Visits to the doctor for flu-like illness decreased again for the 12th week in a row, keeping at a summertime level. No states reported widespread, regional, or local flu activity. Puerto Rico and 27 states reported only sporadic activity, said the CDC.

Three pediatric flu deaths were reported, raising the 2011 season's total to 105. One was from the 2009 H1N1 virus, one was from H3N2, and one was from an unsubtyped influenza A virus. Influenza B was the dominant strain, followed by H3N2, unsubtyped influenza A, and 2009 H1N1, according to the CDC. Routine surveillance for oseltamivir (Tamiflu)-resistant 2009 H1N1 viruses found one more isolate, pushing the season's total to 40.

In global flu developments, a few tropical countries are reporting low-grade transmission, including the Dominican Republic, Venezuela, Jamaica, Rwanda, and Madagascar, the World Health Organization (WHO) said 20 May 2011. The predominant viruses in those locations vary and range from 2009 H1N1 in the Dominican Republic to influenza B in Madagascar.

In Venezuela, an earlier surge in 2009 H1N1 activity that peaked in late March 2011 has now subsided to very low levels. Several countries in Central and South America are reporting increases in respiratory infections due to respiratory syncytial virus (RSV).

Only small numbers of viruses have recently been detected in Europe, North Africa, and the Middle East. Of the few detected, influenza B has been most common. Likewise, in eastern Asian countries such as China and Japan flu levels are very low, with influenza B as the most commonly detected strain, the WHO reported.

So far the surveillance findings don't suggest that flu season has started yet in the Southern Hemisphere's temperate countries, where the season typically runs from May through October. Australia had previously reported higher-than-expected numbers of flu detections in two northern states, but detections have decreased in most areas in recent weeks, the WHO noted. Over the Southern Hemisphere's summer the country reported low-level but persistent H3N2 circulation, but over the past week 2009 H1N1 and influenza B strains have been more frequently detected.
(CIDRAP 5/20/2011)


Global: WHA passes pandemic review, tweaks virus-sharing framework
At the World Health Assembly (WHA) in Geneva on 20 May 2011, the full group adopted a review of the World Health Organization's (WHO's) performance during the 2009 H1N1 pandemic, while a committee made some last-minute changes to a framework for sharing flu viruses.

The pandemic review passed by the plenary group on 20 May 2011 also assesses how the International Health Regulations (IHRs) functioned during the pandemic, which was their first use during a global public health emergency. The WHO announced the passage of the report on its Twitter feed on 20 May 2011.

The independent pandemic review committee issued a draft of its final report in late March 2011. It defended the WHO from accusations that it overstated the pandemic threat and rejected claims that it rushed to declare a pandemic in a move to benefit vaccine makers. The report also included 15 recommendations on how the WHO can improve its future pandemic response.

Gregory Hartl, a WHO spokesman, stated that a WHA committee also adopted an amended resolution to the pandemic virus-sharing agreement, which he said goes to the full group for consideration at the end of May 2011.

According to the resolution draft, available on the WHO's Web site, the amendments included the adoption of the virus-sharing plan's annexes, as well as the main body of the framework. It also asks the WHO director-general to monitor and review the framework's operation and report the progress biennially to the WHA's executive board.

A WHO working group completed its work on the virus-sharing agreement on 16 April 2011, just in time to present it to the WHA. The agreement is designed to ease the sharing of flu viruses so that virologists can characterize and monitor changes, a key component of pandemic preparation. The framework is also intended to ensure that developing countries have affordable access to drugs, vaccines, and diagnostic tools made from the viruses. A WHA committee was scheduled to begin discussing the fate of the remaining stocks of smallpox viruses on 20 May 2011, but Hartl said the talks are now slated to take place 23 May 2011, instead.
(CIDRAP 5/20/2011)


Europe/Near East
UK: More H1N1 pandemic influenza deaths in winter 2011 than during pandemic
Official figures show there were at least 562 deaths linked to the H1N1 virus during the most recent 2011“season” compared with 474 in the global outbreak of 2009.

The young and the middle-aged bore the brunt of the cases with 50 children and nine pregnant women dying across the country. It came after GPs in some areas struggled to access sufficient vaccines, prompting the Government to raid a stockpile from 2010 while hospitals were forced to cancel planned operations in order to care for critically ill flu patients.

In an attempt to avoid a repeat of the recent problems, the Department of Health now hopes to vaccinate far more people including frontline doctors and nurses as well as at-risk groups such as pregnant women and those with long-term diseases. It will also hold a central reserve of jabs and may centralize supply in future years.

Professor John Watson, head of the watchdog’s respiratory diseases department, said the information published in our annual flu report confirms that seasonal flu activity in 2010/11 was higher and that H1N1 ‘swine’ flu was the dominant strain. Sadly, a small proportion of flu cases resulted in serious illness and death, predominantly in young and middle aged adults.
(HealthMap 5/26/2011)


New Zealand: Waikato tops influenza case numbers
With a week to go until winter 2011, Waikato is already seeing more people for suspected flu than anywhere in the country. A strain of flu that killed three school children in 2005 is tipped to turn nasty again this winter, health experts say.

On 16 May 2011, Waikato had the highest number of influenza consultations recorded by GPs nationally, with winter still another week away.

Influenza B, a seasonal strain of the flu responsible for "explosive outbreaks" of the virus, and for killing three healthy school-aged children in 2005, is expected to dominate viruses for 2011/2012.

During the winters of 2010 and 2011, swine flu and another animal-to-human flu called H3N2 were the biggest problems, with swine flu (or H1N1) reaching pandemic levels in 2009 and 2010.

Canterbury District Health Board virologist Dr. Lance Jennings said New Zealanders were affected by influenza every year but of the three viruses circulating in autumn 2011– swine flu, H3N2 and influenza B – he predicted the latter to be on the increase. I suspect for 2011/2012 we will see a mixture of viruses and possibly influenza B affecting us more severely. 2011 vaccination provided cover against all three viruses and was the best protection against the flu, he said.
(HealthMap 5/23/2011)


South Korea: H5N1 avian influenza outbreak in egg farm
On 16 May 2011, South Korea's agriculture ministry reported an H5N1 avian influenza outbreak at an egg farm in Gyeonggi province. The virus killed 600 chickens, and about 17,400 remaining birds on the farm were culled to stop the spread of the disease.
(CIDRAP 5/17/2011)


Viet Nam: Four H5N1 avian influenza outbreaks reported
Agriculture officials in Vietnam have reported four new H5N1 avian influenza outbreaks among poultry in three provinces. In a 15 May 2011 report to the World Organization for Animal Health (OIE), officials said two outbreaks occurred in Vinh Long province and one each in Lang Son and Quang Ngai provinces. Out of 4,542 birds at the affected sites, 3,542 got sick and 277 died. Officials said 3,915 birds were destroyed to arrest the outbreaks. The source of the outbreaks, which affected nine villages, was listed as unknown. The submission on 15 May 2011 was Vietnam's seventh H5N1 outbreak report to the OIE for 2011. The last previous report, on 26 April 2011, cited a separate outbreak in Vinh Long, in southern Vietnam's Mekong Delta.
(CIDRAP 5/16/2011)


South Africa: H5N2 avian influenza hits commercial ostrich farms
In addition, South Africa's agriculture ministry reported 16 May 2011 that the highly pathogen H5N2 virus has hit eight more commercial ostrich farms.. All of the outbreaks occurred at farms in Western Cape Province, located at the southern tip of the country. They affected farms in two cities where outbreaks earlier in 2011 were detected, Oudtshoorn and Uniondale. Routine surveillance showed the poultry were exposed to the disease, but no virus was found. Clinical signs were seen in three of the outbreaks. South Africa has now reported 17 H5N2 outbreaks in commercial ostrich farms for 2011. The outbreaks are the first to hit the flocks since 2006.
(CIDRAP 5/17/2011)


2. Infectious Disease News

Global: U.S. part of growing spread of global measles outbreak
Following large outbreaks of measles in Europe as well as in a growing number of countries around the world, cases are now appearing across the United States. Over the past year, a dramatic increase has been seen in the number of measles cases in such countries as France, Germany, Belgium, Romania, and the UK, and now several American states are reporting an increase in the number of cases as well.

Normally, only about 50 cases of measles occur within the U.S. each year. However, since the beginning of 2011, a total of 98 cases have been reported, according to the Centers for Disease Control and Prevention (CDC). The majority of cases reported have been caused by unvaccinated people traveling to countries where large outbreaks exist.

Among states in the U.S. experiencing an increase in the number of measles cases, Florida has reported five cases that were linked to an international helicopter trade show held in Orlando in April 2011, while three additional cases reported in the Gainesville area were traced to a person who had travelled to India. Also in April 2011, Utah reported nine cases that were linked to a traveller infected while in Poland.

In California, although only 13 cases have been confirmed in 2011, a higher number of cases were reported in April than in March 2011; as well, an increase in cases was noted in March over February 2011. Among the total, four cases required hospitalization.

Minnesota reported a total of 21 cases in February 2011 that were traced back to a child from the Minneapolis area who fell ill after returning home from a trip to Kenya, while in New York, an adult traveler from out of the country sought medical attention in early May 2011 at Winthrop University Hospital in Mineola (Long Island). In addition, five new cases were recently reported in Massachusetts.

Outside the U.S., the spread of measles is affecting many parts of Asia and Africa. In 2010, large outbreaks were reported in Zimbabwe, Zambia, South Africa, Nigeria, Malawi, Lesotho, Ethiopia, and Angola. More than 2000 cases have also been reported in the Philippines so far in 2011.

In Europe, an outbreak has spread through 30 countries, with 6,500 people infected thus far in 2011, but France has been hit the worst with over 5,000 confirmed cases of measles that almost equal the 5,090 cases reported for the entire year of 2010. In addition, the UK has reported a total number of 275 from January to April of 2011.

Although measles once claimed the lives of approximately 500 Americans each year, the disease was declared to be virtually eliminated in the year 2000. But those who do not get vaccinated for the disease are resurrecting the threat to the world's population, as about 90% of unvaccinated people who are exposed to measles fall ill. The disease is transmitted through respiratory particles, especially when people sneeze or cough. In addition, the virus can survive for up to two hours on dry surfaces.

There is no cure or even treatment for measles. The disease simply has to run its course, although doctors can help to treat complications resulting from measles. However, just two doses of the MMR (measles, mumps and rubella) vaccine can protect against the disease and save countless lives.
(Health News 5/16/2011)


Australia: Medical tourism boom raises superbug risk
A growing number of patients travelling overseas for surgery are putting themselves and the Australian health system at risk from deadly superbugs, infectious disease experts say.

Medical tourism companies say more people are choosing to have serious surgery overseas in a shift from the cheap, cosmetic procedures the industry has traditionally performed.

Global Health Travel managing director Cassandra Italia said her company flew about 40 Australian patients a month to countries such as India, Thailand and South Korea for treatments including spinal, orthopedic and bariatric surgery. Since the beginning of 2010, we've seen about a 70% increase in people coming to us just because they don't want to sit on waiting lists, she said. Some people are accessing their superannuation or re-mortgaging their houses to get their surgery done.

But the trend has alarmed experts, including the Austin Hospital's director of infectious diseases, Lindsay Grayson, who said many Australians had returned from overseas surgery extremely ill because they received poor care and picked up foreign superbugs - organisms resistant to antibiotics.

Professor Grayson said the emergence of a new superbug known as NDM-1 - which originated in India and has been found in several Australian patients who had travelled overseas - was genuinely scary because unlike other bugs, it could proliferate and colonize other healthy gut flora inside people's intestines, making them resistant to antibiotics.

This is an incredible threat to the way we practice medicine at the moment, because the NDM-1 gene is resistant to everything except for two drugs, one of which is extremely old and toxic for the kidneys and another which is a very new drug but not very effective, she said. So this is making us very alert to any return traveller, let alone a medical tourist.

Peter Collignon, director of the infectious diseases unit and microbiology at Australian National University, said the threat from NDM-1 was so great that Australian hospitals should be made to isolate return medical tourists until they know they are not carrying superbugs that could contaminate hospitals. These people are risking bringing superbugs into our hospitals and that increases the risks for everyone else, he said.

Ms. Italia said gender-selection IVF procedures were booming in Thailand because of the ban on it for non-medical reasons in Australia. Knee and hip replacements were increasingly popular among Australians not willing to wait six to 12 months for the procedures in the public hospital system, she said.

Central Queensland University economics lecturer Anita Medhekar, who is doing a PhD on the economics of medical tourism, said the industry was worth about $2 billion a year in India alone. She said top hospitals in Thailand and India were offering surgery for less than a third of the price charged in Western countries, describing it as ''a win-win'' for patients and developing countries.

Others disagree, arguing it drives up the cost of healthcare for local people in countries dealing with such issues as high infant and maternal mortality.

Ms. Medhekar said the Indian government was promoting the country as a destination and whole medical cities were being created, complete with research centres and five-star hotels. Ms. Medhekar said groups including the not-for-profit Joint Commission International offered accreditation programs for hospitals around the world to establish minimum standards of quality and safety.

But Professor Collignon said such programs did not address the problem of antibiotic-resistant superbugs such as NDM-1, which has been found in the water supply in Delhi. They are in a country that has very high amounts of antibiotic resistance. Those programs look at processes more directly to do with patient safety and don't take superbugs into account, he said.
(Brisbane Times 5/14/2011)


Australia: Murray Valley encephalitis in a returning Canadian traveller
Murray Valley encephalitis virus (MVEV) has been identified in the cerebrospinal fluid of a 19-year-old female who recently returned from travel in the Northern Territory of Australia, an area endemic for MVEV due to recent floods.

She had spent six months working at a farm in New Zealand, followed by a ten day vacation in Australia, camping and spelunking in the Darwin and Alice Springs area. She returned to Canada by way of New Zealand. The day prior to her departure on 13 May 2011 from Auckland to Calgary, Alberta, she reported feeling tired. Upon her return home her tiredness persisted which was attributed to jet lag. However, with the development of rigors, chills, and increasing confusion, she was taken to hospital for medical assessment. On 17 May 2011 she was admitted to the ICU at a tertiary medical facility in Calgary for further investigation.

This is the first laboratory confirmed case of MVEV reported in Canada and serves as a cautionary reminder of the other viral etiologies that should be considered in returning travelers that may be outside the diagnostic capability of many clinical laboratories. Appropriate samples should also be referred to centres where specialized testing is available to determine a probable viral etiology.

Despite intensive medical and surgical interventions, she developed progressive cerebral edema, progressing to neurological death on day eight of her hospitalization.
(ProMED 5/26/2011)


Hong Kong: Nursery school with hand, foot and mouth disease outbreak
The Christian and Missionary Alliance Lei Tung Nursery School has been advised by the Department of Health's Centre for Health Protection (CHP) to suspend classes from 24 May 2011 until 6 June 2011, following an outbreak of hand, foot and mouth disease (HFMD) affecting five pupils. Four boys and one girl, aged three to four, developed symptoms of HFMD since 13 May 2011. All of them sought medical treatment. No hospitalization was required. They are now in stable condition.

The stool samples of two affected students tested positive for enterovirus 71 (EV71). The school management has stepped up infection control measures according to the CHP's advice following their visit on 19 May 2011.

As two more pupils were on 23 May 2011 reported to be affected with HFMD, the school was advised to suspend classes for thorough disinfection and to interrupt virus transmission.

There have been 19 EV71 cases so far in 2011. There were 101 EV71 cases in 2010 and 31 EV71 cases in 2009.

A CHP spokesman reminded the public to maintain strict personal and environmental hygiene during HFMD outbreaks and to adopt the following preventive measures:
(ProMED 5/23/2011)


Indonesia (Bali): German tourist diagnosed with Japanese encephalitis
A 54-year-old woman was diagnosed with Japanese encephalitis (JE) on 18 May 2011. She is currently under treatment in the Medical Mission Hospital, Wurzburg, Germany. Virological investigations of serum and CSF samples were performed at the Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Center for Arboviruses, Hamburg, Germany.

Together with her husband, the woman spent two weeks in Bali, Indonesia during 15 to 30 April 2011. She visited many tourist sites and went upcountry but did not stay in particularly low budget accommodations. She was not vaccinated for JE.

The patient developed an unspecific febrile illness on 2 May 2011, which lasted three days. After a short recovery, fever came back on 9 May 2011 together with speech disorders, lethargy and ataxia, and, therefore, a JE virus infection was suspected. The patient is currently recovering; severe sequelae are not expected, but it is still too early to evaluate the definitive outcome. Her husband remains healthy up to 19 May 2011.

To our knowledge, this is the first recorded case of a laboratory-confirmed JE virus infection in a German tourist returning from Bali, which is a favorite site for short term and last minute travel. German health authorities were given all available information about the case, enabling them to update JE vaccination strategies for German travelers.
(ProMED 5/19/2011)


New Zealand: Possible cases of Legionella identified
Nelson Marlborough Public Health Service (PHS) has identified another five possible cases of legionellosis in their investigation to find a source of the illness and search for further cases. PHS were visiting businesses in the Riverlands Industrial Estate after three confirmed cases of Legionella were reported and three suspected cases were identified earlier in May 2011.

Medical officer of health, Dr. Ed Kiddle said, following visits to the Riverlands Industrial Area the week of 16 May 2011, we have identified five more possible cases of people who have had respiratory infections that could fit with legionellosis over the period since the beginning of April 2011.

He said that these infections could also be due to a virus or different bacteria and blood tests were being arranged where possible to see if Legionella could be confirmed. He said that as this testing required two blood samples to be taken some weeks apart the results wouldn't be available until later in June 2011.

With the additional five cases there are now eight suspected cases of legionellosis and three confirmed cases from this industrial estate area.

To identify a source of the infection we have been working with Marlborough District Council (MDC) and the Department of Labour (DoL) to identify all cooling towers in Blenheim and have sampled water from some towers in the immediate area of concern.

The first results from these cooling tower samples are expected on 24 May 2011. Towers have been shock-dosed with chemicals to cover any risk if they had been contaminated with Legionella and the DoL are contacting other premises in the wider Blenheim area with advice on management of cooling towers, said Dr. Kiddle.

In addition PHS had taken samples from compost piles in the Riverlands Industrial area to further investigate possible sources for Legionella.
(ProMED 5/25/2011)


Russia: Tick-borne encephalitis contracted by consumption of goat milk
The Kaliningrad regional division of Rospotrebnadzor (Federal service on customers' rights protection and human well-being surveillance) has described a case of an 8-year-old child who contracted tick-borne encephalitis (TBE) after consumption of raw goat milk.

Raw goat milk is an established source of TBE infection during the epidemic season. Goat milk is being preferentially given to children since it is less allergenic.

Rospotrebnadzor strongly recommends boiling the milk before consumption. There were two similar cases in the region in 2009 and six cases in 2010.
(ProMED 5/20/2011)


Russia: Crimean-Congo hemorrhagic fever
The regional division of Rospotrebnadzor (Federal service on customers' rights protection and human well-being surveillance) has reported a worsening of the Crimean-Congo hemorrhagic fever (CCHF) situation in the Rostov region. A total of three laboratory confirmed cases have been identified in two regions of the Rostov Oblast. The infections followed exposure to tick bites. As of May 2011, some 617 people, including 186 children under 14 years of age, have sought medical treatment for tick bites.

[ProMED note: The Rostov Oblast is the second region in Russia besides Kalmykia where CCHF cases have been recorded in 2011. In 2010, 16 of 64 cases of CCHF occurred in the Rostov Oblast of the South Federal Okrug of Russia. In 70% of cases exposure to tick bites was confirmed.]
(ProMED 5/21/2011)


Russia: Rabid dogs bite 12 inhabitants of Moscow suburbs
During the holiday period at the beginning of 12 May 2011, 12 people in the suburbs of Moscow were bitten by rabid dogs: Ten were residents of the Naro-Fominskiy district, and two were residents of the Istrinskiy district. Another six people were bitten in Dedenevo village in Naro-Fominskiy district, and four were in contact with a sick cat in the village of Babukino in the Naro-Fominskiy district. Another two people were bitten by a sick dog in the Istrinsky district. In each situation the animals were confirmed to be rabid by laboratory diagnosis.

In April 2011 a 39-year-old woman died from rabies in Moscow. In December 2010 another woman who had visited Goa, and had been bitten by a stray puppy on 29 December 2010, failed to seek medical treatment on return to Moscow and died from rabies in the middle of April 2011.

Previously in November and December 2010, two persons died from rabies virus infection in Moscow. In addition a 10-year-old girl was bitten by a raccoon dog in Astrakhan where she was staying with her parents. Also in August 2010 a 23-year-old local man, who had been bitten by cat in Moldova, died in Moscow where he had gone to seek employment.

During the first five months of 2011, some 50 cases of rabies in animals have been recorded in the Moscow region. By comparison in 2010 there were 153 cases and 260 cases in 2009.

The Moscow region is surrounded by natural foci of rabies. The most unfavorable locations are the Lotoshinskiy, Ruzsky, Istrinsky, and Dmitrovsky districts. The main vectors include foxes, raccoon dogs, and domestic animals (dogs and cats). More rarely rabies has been recorded in elk, beaver, hedgehog and polecat. An unfavorable situation remains in three districts which directly impinge on the Moscow region -- the Krasnogorsky, Leninsky and Odintsovsky districts where rabies continues to be prevalent. However since 2008 no rabid animals have been recorded in Moscow city.
(ProMED 5/21/2011)


Viet Nam: City hospital reports another pig bacterium case
The Tropical Disease Hospital in Ho Chi Minh City reported another patient contracted Streptococcus suis or “pig bacterium” on 16 May 2011, raising the number of infected cases to 11 since the beginning of 2011.

The patient, 57-years-old, resides in Ninh Thuan Province and was hospitalized with high fever and organ disorder. Doctors say the patient was infected with S. suis because of eating pig-blood curd. Fortunately, the patient is showing signs of recovery.

According to health experts, people can contract the S. suis bacterium through unhygienic or diseased pork. Infected patients show symptoms of nausea, fever, vomiting and bleeding. Doctors have warned people not to eat diseased pigs.
(ProMED 5/19/2011)


Chile (Biobio): Sixth confirmed case of hantavirus in 2011
The Health SEREMI (Regional Ministerial Secretariat) of the Biobio region confirmed the sixth case of a hantavirus infection in 2011 in the area, which became the fourth fatality.

The case is a 64-year-old man from the Canete community in Arauco, although the way in which he became infected is still being investigated. The exact location of the place where he might have been infected is being investigated, but his home that was visited has the conditions for the infection, explained the Biobio Health SEREMI epidemiologist Cecilia Soto. The patient went for treatment to the Canete hospital and was immediately referred to the regional hospital, but regretfully, he died, she added.
(ProMED 5/23/2011)


Chile (Maule): New case of hantavirus infection
A new case of a hantavirus infection was registered in the Maule region, this time in the Longavi community, Linares province. Initially, the man, a 38-year-old farmer, was sent to the intensive care unit in the Curico Hospital, in stable but serious condition, but did not require mechanical ventilation and in the coming hours will be sent to the care center in Linares.

According to the investigation initiated by the Health SEREMI, the risk area corresponds to the San Ramon de Bodega sector where he lives and according to the epidemiological investigation, there is a high risk in his work area and around the house. Currently, the health authority is completing the analysis to confirm the specific place of risk.

In 2010, in Maule there were there were 11 cases of hantavirus infections, three of whom died, equivalent to 27.2% fatality. 61 cases and 22 deaths were reported in the country, a 36% fatality, within the normal range for this disease. In 2011, four cases of hantavirus infections have been registered, three of which were mild and one fatal, in the Molina, San Clemente, Curepto, and now Longavi communities. The cases correspond to three farm workers and a housewife, one of whom died.

According to the Department of Public Health, in Chile 30 cases of hantavirus infections have been registered, with a 33% fatality rate.
(ProMED 5/23/2011)


USA (Maine): Rodent-borne virus makes first appearance
The first-ever reported case in Maine of a potentially fatal respiratory condition spread by the common house mouse was diagnosed in Somerset County at the end of April 2011. Hantavirus pulmonary syndrome, or HPS, has a rapid onset of illness, no effective vaccine or cure, and a fatality rate of 30% to 40%.

Mainers should not be unduly alarmed, said Dr. Stephen Sears, the state epidemiologist. There are many potentially dangerous diseases associated with the white-footed mouse, the deer mouse, and other common rodents, he said on 18 May 2011, and the presence of hantavirus in Maine comes as no surprise to epidemiologists or other public health officials.

This raises the issue that you really need to clean up if your environment includes mice and other rodents, he said. Especially in camps and cottages where mice may become well established during the winter months, people should be careful when handling droppings, nests, and other sources of contamination.

The Somerset County man diagnosed last month is in his 70s, Sears said. He became very ill very quickly, Sears said, and was treated in the intensive care unit of a nearby hospital. Doctors suspected HPS and sent a blood specimen to an out-of-state laboratory. The presence of a hantavirus was confirmed at the US CDC in Atlanta.

Thanks to a quick medical response, the man survived the episode but continues to recover in a rehabilitation facility. Sears said he expects the man will be able to return to his own home.

State inspectors visiting the man's property found mouse contamination in an outbuilding, Sears said.

We take it for granted in Maine that living with mice is part of living in the country, Sears said. But this case, he noted, shows that Mainers should be vigilant about controlling mice and other rodents in their homes and cleaning up after them carefully.

[ProMED note: The hantavirus involved in this cases is probably either New York virus, Monongahela virus or Sin Nombre virus (SNV). All can cause hantavirus pulmonary syndrome. The sigmodontine hosts of Sin Nombre (SNV) and Monongahela viruses is the deer mouse, Peromyscus maniculatus, which is widely distributed in the USA, including Maine. The white-footed mouse, P. leucopus is also a SNV reservoir. P.leucopus is the host for New York hantavirus, and is also found in Maine.]
(ProMED 5/23/2011)


USA (California): Local health officials confirm case of measles in San Luis Obispo County
San Luis Obispo County Public Health officials confirmed a case of measles in a San Luis Obispo county resident who had recently returned from France. Officials say this is the first case of measles in the county in about 20 years and that there have only been 13 cases of the virus in California in 2011. On the flip side, health officials say measles has been seen in epidemic levels in France over the past two years.

Public health officials say the local patient returned to the county in a private car and had not visited any local businesses or public places, other than a local hospital.
(KSBY News 5/18/2011)


USA (Massachusetts): Two more confirmed cases of measles
There are two more confirmed cases of the measles in Massachusetts. Both were discovered the week of 16 May 2011, bringing the state's total to 15. According to the Brookline Public Health Department, the two cases are students at Michael Driscoll School in Brookline. The students are related, but no names or ages have been revealed. The school has students from kindergarten through eighth grade.

The two infected students have a religious exemption for immunizations. It's not clear yet how they came down with the measles. Both are now recovering at home. Four other students at the school also have the religious exemption. They are not sick. However, they have been sent home for a week as a precaution.
(CBS Boston 5/20/2011)


USA (New York): Student confirmed to have measles
New York state health officials confirm a Rensselaer Polytechnic Institute (RPI) student in Troy has measles and may have exposed the public to the disease.

State and local health departments are advising people who may have been exposed and who have symptoms consistent with measles to call their healthcare providers or a local emergency room before going for care to help prevent others in a healthcare setting from being exposed to the disease.

RPI officials say ten students have not been immunized for measles, including the student who currently has measles. Preventive treatment for measles must be given within six days of the exposure to be effective.

Measles exposure may have occurred at the RPI campus from 8 to 16 May 2011; a health food store and drug store on 12 May 2011; Troy's Samaritan Hospital emergency room on 12 to 13 May 2011, and Albany Medical Center Hospital emergency room on 13 to 24 May 2011.
(ProMED 5/22/2011)


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.


Hong Kong
On 18 May 2011, the Centre for Health Protection (CHP) of the Department of Health is investigating two related imported cases of dengue fever and urged people to take precautions against the disease.

The first patient was a 52-year-old man who developed fever, myalgia and retro-orbital pain on 6 May 2011. The patient consulted a private doctor on the same day. He recovered and no hospitalization was required. His friend, a 57-year-old man, also presented with fever on 6 May 2011. He saw a private doctor on the same day. The patient recovered uneventfully and no hospitalization was required. Blood samples from both men tested positive for dengue virus.

The CHP's investigation revealed that both patients had travelled to Phuket, Thailand, in April and May 2011. The household contacts of the two patients are asymptomatic. The CHP will continue to follow up on the cases.

A total of eight cases of imported dengue fever have been reported to the CHP so far in 2011. There were 79 imported cases and four local cases in 2010.

[ProMED note: Aedes albopictus is the only dengue virus vector present in Hong Kong, so there is a risk, however slight, of ongoing local dengue virus transmission in this densely populated city. However, there have been several imported dengue cases over recent years without initiating local transmission.]
(ProMED 5/23/2011)

From the beginning of 2011 until 10 May 2011, there have been 9,418 dengue fever patients nationwide and seven fatalities, whereas 16,110 patients and 20 fatalities were recorded during the same period in 2010. The central region has the most infections so far with 5,244 plus one death, followed by the south with 1,796 patients and two deaths. Provinces most prone to dengue fever include Krabi, Samut Sakhon, Satun, Songkhla, Ratchaburi, Nakhon Pathom, Nakhon Sawan, Chon Buri and Trat.
(ProMED 5/16/2011)


4. Articles
The Usefulness of Case Reports in Managing Emerging Infectious Disease
Wiwanitkit V. Journal of Medical Case Reports. 20 May 2011; 5:194. doi:10.1186/1752-1947-5-194.
Available at http://www.jmedicalcasereports.com/content/5/1/194

Abstract. Emerging infectious diseases are an important problem in medicine. Case reports usually document episodes in the early emerging phase or in a small outbreak. Although the case report is considered weak evidence in medical literature, it is usually the first report when there is a new emerging infectious disease. There is no doubt that case reports can provide useful information for further case series, reviews and studies. This editorial focuses on the usefulness of the case report on emerging infectious disease to the medical society. Publication in this area is highly welcomed by the journal and can serve as a future point of reference.


Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review
Revere D, Nelson K, Thiede H, et al.BMC Public Health. 18 May 2011; 11(1):337. [Epub ahead of print]
Available at http://www.ncbi.nlm.nih.gov/pubmed/21592390

Background. Health care providers (HCPs) play an important role in public health emergency preparedness and response (PHEPR) so need to be aware of public health threats and emergencies. To inform HCPs, public health issues PHEPR messages that provide guidelines and updates, and facilitate surveillance so HCPs will recognize and control communicable diseases, prevent excess deaths and mitigate suffering. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. We conducted a literature review to investigate the systems and tools used by public health to generate PHEPR communications to HCPs, and to identify specific characteristics of message delivery mechanisms and formats that may be associated with effective PHEPR communications.

Methods. A systematic review of peer- and non-peer-reviewed literature focused on the following questions: 1) What public health systems exist for communicating PHEPR messages from public health agencies to HCPs? 2) Have these systems been evaluated and, if yes, what criteria were used to evaluate these systems? 3) What have these evaluations discovered about characterizations of the most effective ways for public health agencies to communicate PHEPR messages to HCPs?

Results. We identified 25 systems or tools for communicating PHEPR messages from public health agencies to HCPs. Few articles assessed PHEPR communication systems or messaging methods or outcomes. Only one study compared the effectiveness of the delivery format, device or message itself. We also discovered that the potential is high for HCPs to experience "message overload" given redundancy of PHEPR messaging in multiple formats and/or through different delivery systems.

Conclusions. We found that detailed descriptions of PHEPR messaging from public health to HCPs are scarce in the literature and, even when available, are rarely evaluated in any systematic fashion. To meet present-day and future information needs for emergency preparedness, more attention needs to be given to evaluating the effectiveness of these systems in a scientifically rigorous manner.


Knowledge, Attitudes and Practices KAP related to the Pandemic (H1N1) 2009 among Chinese General Population: a Telephone Survey
Lin Y, Huang L, Nie S, et al. BMC Infect Dis. 16 May 16 2011; 11(1):128. [Epub ahead of print]
Available at http://www.ncbi.nlm.nih.gov/pubmed/21575222

Background. China is at greatest risk of the Pandemic (H1N1) 2009 due to its huge population and high residential density. The unclear comprehension and negative attitudes towards the emerging infectious disease among general population may lead to unnecessary worry and even panic. The objective of this study was to investigate the Chinese public response to H1N1 pandemic and provide baseline data to develop public education campaigns in response to future outbreaks.

Methods. A close-ended questionnaire developed by the Chinese Center for Disease Control and Prevention was applied to assess the knowledge, attitudes and practices KAPof pandemic (H1N1) 2009 among 10,669 responders recruited from seven urban and two rural areas of China sampled by using the probability proportional to size (PPS) method.

Results. 30.0% respondents were not clear whether food spread H1N1 virusand. 65.7% reported that the pandemic had no impact on their life. The immunization rates of the seasonal flu and H1N1vaccine were 7.5% and 10.8%, respectively. Farmers and those with lower education level were less likely to know the main transmission route (cough or talk face to face). Female and those with college and above education had higher perception of risk and more compliance with preventive behaviors. Relationships between knowledge and risk perception (OR=1.69; 95%CI 1.54-1.86), and knowledge and practices (OR=1.57; 95%CI 1.42-1.73) were found among the study subjects. With regard to the behavior of taking up A/H1N1 vaccination, there are several related factors found in the current study population, including the perception of life disturbed (OR=1.29; 95%CI 1.11-1.50), the safety of A/H1N1 vaccine (OR=0.07; 95%CI 0.04-0.11), the knowledge of free vaccination policy (OR=7.20; 95%CI 5.91-8.78), the state's priority vaccination strategy(OR=1.33; 95%CI 1.08-1.64), and taking up seasonal influenza vaccine behavior (OR=4.69; 95%CI 3.53-6.23).

Conclusions. This A/H1N1 epidemic has not caused public panic yet, but the knowledge of A/H1N1 in residents is not optimistic. Public education campaign may take the side effects of vaccine and the knowledge about the state's vaccination strategy into account.


A Postmarketing Evaluation of the Frequency of Use and Safety of Live Attenuated Influenza Vaccine use in Nonrecommended Children Younger than 5 years
Tennis P, Toback SL, Andres E, et al. Vaccine. 17 May 2011. doi:10.1016/j.vaccine.2011.04.113 .
Available at http://www.sciencedirect.com/science/article/pii/S0264410X11006797

Abstract. The 2007 US approval for use of live attenuated influenza vaccine (LAIV) in children aged 24–59 months included precautions against use in (1) children <24 months and children aged 24–59 months with (2) asthma, (3) recurrent wheezing, and (4) altered immunocompetence. A postmarketing commitment was initiated to monitor LAIV use and the frequency of select safety outcomes in these cohorts. Vaccination rates and the frequency of hospitalizations or emergency department visits within 42 days after LAIV and trivalent inactivated influenza vaccine (TIV) administration were estimated from 2007 to 2009 claims data from a health insurance database. Rates of LAIV use per 10,000 child-days among cohorts 1, 2, and 4 were low relative to rates among the LAIV-recommended population (2007–2008; 0.03–0.78 vs. 1.32, 2008–2009; 0.08–3.26 vs. 5.94). However, rates of LAIV use per 10,000 child-days in cohort 3 were similar to rates among the LAIV-recommended population (2007–2008; 1.55 vs. 1.32, 2008–2009; 5.01 vs. 5.94). The rate of emergency department visits/hospitalizations within 42 days of vaccination with LAIV was the same as or less than the rate within 42 days of vaccination with TIV. Less restricted LAIV use in children with past wheezing may be related to the broad definition of recurrent wheezing used in national guidelines and the current study. In the small number of nonrecommended children receiving LAIV, no safety signals were identified.


Characterizing the Epidemiology of the 2009 Influenza A/H1N1 Pandemic in Mexico.
Chowell G, Echevarría-Zuno S, Viboud C, et al. PLoS Med. 24 May 2011; 8(5): e1000436. doi:10.1371/journal.pmed.1000436
Available at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000436

Background. Mexico's local and national authorities initiated an intense public health response during the early stages of the 2009 A/H1N1 pandemic. In this study we analyzed the epidemiological patterns of the pandemic during April–December 2009 in Mexico and evaluated the impact of nonmedical interventions, school cycles, and demographic factors on influenza transmission.

Methods and Findings. We used influenza surveillance data compiled by the Mexican Institute for Social Security, representing 40% of the population, to study patterns in influenza-like illness (ILIs) hospitalizations, deaths, and case-fatality rate by pandemic wave and geographical region. We also estimated the reproduction number (R) on the basis of the growth rate of daily cases, and used a transmission model to evaluate the effectiveness of mitigation strategies initiated during the spring pandemic wave. A total of 117,626 ILI cases were identified during April–December 2009, of which 30.6% were tested for influenza, and 23.3% were positive for the influenza A/H1N1 pandemic virus. A three-wave pandemic profile was identified, with an initial wave in April–May (Mexico City area), a second wave in June–July (southeastern states), and a geographically widespread third wave in August–December. The median age of laboratory confirmed ILI cases was ~18 years overall and increased to ~31 years during autumn (p<0.0001). The case-fatality ratio among ILI cases was 1.2% overall, and highest (5.5%) among people over 60 years. The regional R estimates were 1.8–2.1, 1.6–1.9, and 1.2–1.3 for the spring, summer, and fall waves, respectively. We estimate that the 18-day period of mandatory school closures and other social distancing measures implemented in the greater Mexico City area was associated with a 29%–37% reduction in influenza transmission in spring 2009. In addition, an increase in R was observed in late May and early June in the southeast states, after mandatory school suspension resumed and before summer vacation started. State-specific fall pandemic waves began 2–5 weeks after school reopened for the fall term, coinciding with an age shift in influenza cases.

Conclusions. We documented three spatially heterogeneous waves of the 2009 A/H1N1 pandemic virus in Mexico, which were characterized by a relatively young age distribution of cases. Our study highlights the importance of school cycles on the transmission dynamics of this pandemic influenza strain and suggests that school closure and other mitigation measures could be useful to mitigate future influenza pandemics.


Racial and Ethnic Disparities in Uptake and Location of Vaccination for 2009-H1N1 and Seasonal Influenza
Usher-Pines L, Maurer J, Harris K. Am J of Public Health. Published online ahead of print 12 May 2011; e1-e4. doi:10.2105/AJPH.2011.300133.
Available at http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2011.300133v1

Background. To learn more about racial and ethnic disparities in influenza vaccination during the 2009-H1N1 pandemic, we examined nationally representative survey data of US adults. We found disparities in 2009-H1N1 vaccine uptake between Blacks and Whites (13.8% vs 20.4%); Whites and Hispanics had similar 2009-H1N1 vaccination rates. Physician offices were the dominant location for 2009-H1N1 and seasonal influenza vaccinations, especially among minorities. Our results highlight the need for a better understanding of how communication methods and vaccine distribution strategies affect vaccine uptake within minority communities.


Circulating Influenza Virus, Climatic Factors, and Acute Myocardial Infarction: A Time Series Study in England and Wales and Hong Kong
Warren-Gash C, Bhaskaran K, Hayward A, et al. J of Infectious Diseases. 2011; 203 (12): 1710-1718. doi: 10.1093/infdis/jir171.
Available at http://jid.oxfordjournals.org/content/203/12/1710.short

Background. Previous studies identifying associations between influenza and acute cardiac events may have been confounded by climatic factors. Differing seasonal patterns of influenza activity in Hong Kong and England and Wales provide a natural experiment to examine associations with myocardial infarction (MI) independent of cold weather effects.

Methods. Weekly clinical and laboratory influenza surveillance data, environmental temperature and humidity data, and counts of MI-associated hospitalizations and deaths were obtained for England and Wales and for Hong Kong for the period 1998–2008. We used Poisson regression models that included environmental and seasonal variables to investigate the relationship between influenza and MI.

Results. There were ≥1.2 million MI-associated hospitalizations and 410,204 MI-associated deaths in England and Wales, with a marked peak in the winter season. In Hong Kong, the incidence of MI, on the basis of 65,108 hospitalizations and 18,780 deaths, had a large winter and smaller summer peak, mirroring patterns of influenza activity. There was strong evidence for a link between influenza and MI both in England and Wales, where 3.1%–3.4% of MI-associated deaths (P < .001) and 0.7%–1.2% of MI-associated hospitalizations (P < .001) were attributable to influenza, and in Hong Kong, where the corresponding figures were 3.9%–5.6% (P = .018) and 3.0%–3.3% (P = .002).

Conclusions. Influenza was associated with an increase in MI-associated deaths and hospitalizations in 2 contrasting settings


Trends in Malaria Research in 11 Asian Pacific Countries: An Analysis of Peer-Reviewed Publications over Two Decades
Andersen F, Douglas NM, Bustos D, et al. Malar J. 18 May 201; 10(1):131. [Epub ahead of print]
Available at http://www.ncbi.nlm.nih.gov/pubmed/21586174

Background. Quantitative data are lacking on published malaria research. The purpose of the study is to characterize trends in malaria-related literature from 1990 to 2009 in 11 Asian-Pacific countries that are committed to malaria elimination as a national goal.

Methods. A systematic search was conducted for articles published from January 1990 to December 2009 in PubMed/MEDLINE using terms for malaria and 11 target countries (Bhutan, China, North Korea, Indonesia, Malaysia, Philippines, Solomon Islands, South Korea, Sri Lanka, Thailand and Vanuatu). The references were collated and categorized according to subject, Plasmodium species, and whether they contained original or derivative data.

Results. 2,700 articles published between 1990 and 2009 related to malaria in the target countries. The annual output of malaria-related papers increased linearly whereas the overall biomedical output from these countries grew exponentially. The percentage of malaria-related publications was nearly 3% (111/3741) of all biomedical publications in 1992 and decreased to less than 1% (118/12171; p<0.001) in 2009. Thailand had the highest absolute output of malaria-related papers (n=1211), followed by China (n=609) and Indonesia (n=346). Solomon Islands and Vanuatu had lower absolute numbers of publications, but both countries had the highest number of publications per capita (1.3 and 2.5 papers/1,000 population). The largest percentage of papers concerned the epidemiology and control of malaria (53%) followed by studies of drugs and drug resistance (47%). There was an increase in the proportion of articles relating to epidemiology, entomology, biology, molecular biology, pathophysiology and diagnostics from the first to the second decade, whereas the percentage of papers on drugs, clinical aspects of malaria, immunology, and social sciences decreased.

Conclusions. The proportion of malaria-related publications out of the overall biomedical output from the 11 target Asian-Pacific countries is decreasing. The discovery and evaluation of new, safe and effective drugs and vaccines is paramount. In addition the elimination of malaria will require operational research to implement and scale up interventions.


Measles --- United States, January--May 20, 2011
Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 27 May 2011; 60(20):666-668.
Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6020a7.htm?s_cid=mm6020a7_w

Abstract. Measles is a highly contagious, acute viral illness that can lead to serious complications and death. Endemic or sustained measles transmission has not occurred in the United States since the late 1990s, despite continued importations (1). During 2001--2008, a median of 56 (range: 37--140) measles cases were reported to CDC annually (2); during the first 19 weeks of 2011, 118 cases of measles were reported, the highest number reported for this period since 1996. Of the 118 cases, 105 (89%) were associated with importation from other countries, including 46 importations (34 among U.S. residents traveling abroad and 12 among foreign visitors). Among those 46 cases, 40 (87%) were importations from the World Health Organization (WHO) European and South-East Asia regions. Of the 118, 105 (89%) patients were unvaccinated. Forty-seven (40%) patients were hospitalized and nine had pneumonia. The increased number of measles importations into the United States this year underscores the importance of vaccination to prevent measles and its complications.


5. Notifications
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/


Conference on Crisis Management in the Food Chain: presentations available online
Over 350 people from 300 organizations, companies and countries took part in the conference on "Crisis Management in the Food Chain", 19 to 20 May 2011 in Brussels. Subjects ranged from the dangers of modelling, the EU response to avian flu, animal welfare in times of crisis, how the UK has moved on since FMD in 2001, capacity-building in developing countries to what we have got wrong/right in the media.
Presentations, videos, and photographs from the conference are now available online at