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Vol. XIV No, 12 ~ EINet News Briefs ~ Jun 10, 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: H5N1 avian influenza cases in Egypt and Indonesia
- Germany: H7N3 avian influenza strikes poultry farm
- Australia (Queensland): Influenza cases up 50%
- Chinese Taipei: Low-path H7N3 avian influenza outbreak
- Indonesia: WHO confirms child's H5N1 avian influenza infection
- Viet Nam: H5N1 poultry vaccination halted due to poor match
- Canada: Reassortant pandemic H1N1–seasonal H3N2 influenza virus found in toddler
- USA: Experts say influenza shot is best hedge over uncertainty of duration of immunity
- Bolivia: Seven new A/H1N1 pandemic influenza cases

2. Infectious Disease News
- Global: EHEC outbreak update
- Germany: Source of E. coli outbreak — it was the sprouts after all
- China: More than 100 children get viral encephalitis
- New Zealand: Cooling tower suspected in Legionnaires’ outbreak
- New Zealand: Measles outbreak hits Auckland
- Russia: Five persons infected with brucellosis in the Volgograd region
- Russia: Two brucellosis outbreaks in Orenburg
- Viet Nam: Hand, food and mouth disease in Ho Chi Minh City
- Viet Nam: Quang Ngai reports second death from hand, foot and mouth disease
- Chile: Poor air quality exacerbates respiratory syncytial virus outbreak
- USA: Multistate outbreak of human Salmonella Altona infections
- USA (New Mexico): Second case of bubonic plague in 2011
- USA (Colorado): Two dead from outbreak of Listeria
- USA (New Mexico): State investigates measles case in Otero County
- USA (Utah): Cache County child has confirmed case of measles

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

4. Articles
- 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
- Different Immune Responses to Three Different Vaccines following H6N1 Low Pathogenic Avian Influenza Virus Challenge in Taiwanese Local Chicken Breeds
- Recent Progress of Shiga Toxin Neutralizer for Treatment of Infections by Shiga Toxin-Producing Escherichia coli
- The Aftermath of the Western Australian Melioidosis Outbreak
- Sex Differences in the Incidence and Case Fatality Rates from Hemorrhagic Fever with Renal Syndrome in China, 2004-2008
- Global Health Education Consortium: 20 Years of Leadership in Global Health and Global Health Education
- Global Health: the Twenty-First Century Global Health Priority Agenda
- Current and Nano-Diagnostic Tools for Dengue Infection
- Review: Genetics of Infectious Diseases: Hidden Etiologies and Common Pathways
- Review of Cases with the Emerging Fifth Human Malaria Parasite, Plasmodium knowlesi
- Health Care-Associated Measles Outbreak in the United States after an Importation: Challenges and Economic Impact
- Viral Etiology of Acute Lower Respiratory Tract Infections in Hospitalized Young Children in Northern Taiwan
- The Virology, Epidemiology, and Clinical Impact of West Nile Virus: a Decade of Advancements in Research since Its Introduction into the Western Hemisphere
- Clinical Significance of Nontuberculous Mycobacteria Isolates in Elderly Taiwanese Patients
- Pandemic Response Lessons from Influenza H1N1 2009 in Asia

5. Notifications
- Radio panel discussion on Europe E. coli outbreak
- Global to Local: Implementing the International Health Regulations (2005)
- ISID-Neglected Tropical Diseases Meeting
- 5th Ditan International Conference on Infectious Diseases
- Influenza 2011: Zoonotic Influenza and Human Health


1. Influenza News

Global
2011 Cumulative number of human cases of avian influenza A/H5N1
Economy / Cases (Deaths)
Bangladesh / 2 (0)
Cambodia / 5 (5)
Egypt / 25 (8)
Indonesia / 7 (5)
Total / 39 (18)

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

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 555 (324) (WHO 6/3/2011)
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2011_06_3/en/index.html

Avian influenza age distribution data from WHO/WPRO (last updated 2/7/2011):
http://www.wpro.who.int/sites/csr/data/data_Graphs.htm

WHO's map showing world's areas affected by H5N1 avian influenza (status as of 2/12/10):
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1Human_2010_FIMS_20100212.png

WHO’s timeline of important H5N1-related events (last updated 4/4/11):
http://www.who.int/csr/disease/avian_influenza/2011_04_04_h5n1_avian_influenza_timeline_updates.pdf

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Global: H5N1 avian influenza cases in Egypt and Indonesia
On 1 June 2011 health officials reported two new H5N1 avian influenza cases, in an Egyptian woman who died from the disease and in an Indonesian toddler who is recovering.

Egypt's health ministry said the 30-year-old woman from Alexandria governorate got sick on 26 April 2011 and was hospitalized on 3 May 2011, where she was placed on a ventilator and received oseltamivir (Tamiflu). She died on 9 May 2011. An investigation into the source of her illness revealed she had been exposed to poultry that had suspected avian influenza. Her case is Egypt's 144th, and her death is the country's 48th from the disease.

Indonesia's health ministry recently announced an H5N1 infection in a 14-month-old North Jakarta boy who has recovered. The ministry said in a translated report that he came down with flu symptoms on 3 April 2011 and was referred to an avian influenza referral hospital on 8 April 2011, where he received intensive treatment and was diagnosed as having bronchopneumonia.

If the boy's illness is confirmed by the WHO, he will be listed as Indonesia's 178th H5N1 case-patient, of whom 146 died from the disease.

An epidemiological investigation into the boy's illness found that a week before he got sick he had visited a poultry market in his neighborhood where he held a free-range chicken. The health ministry said it has informed the WHO about the case. Final confirmation of the boy's infection, plus the official announcement of Egypt's latest illness and death, would push the global H5N1 count to 555 cases, including 324 deaths.
(CIDRAP 6/1/2011)

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Europe/Near East
Germany: H7N3 avian influenza strikes poultry farm
German animal health officials confirmed an H7N3 outbreak at a poultry farm in North Rhine-Westphalia state. Serotyping test results are pending. The report said 20,000 birds were culled to curb the spread of the virus.
(CIDRAP 5/27/2011)

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Asia
Australia (Queensland): Influenza cases up 50%
Flu cases in Queensland have increased by more than half since 2010, causing concern among doctors about an early on-set of flu season. The Australian Medical Association Queensland has revealed close to 1,600 cases of flu have been reported across the state for 2011, with as many as 460 cases reported over May 2011 alone. As many as 30% of the flu cases reported were the H1N1 virus, more commonly known as swine flu.

President Gino Pecoraro said it was unusual to see seasonal flu early in the year. He stated that it may be related to the fact we had a particularly wet summer and so people have been indoors rather than outdoors. When you have people close together it is much easier to spread the virus because it is spread by infection in the air. Dr. Pecoraro urged residents to take precautions such as covering mouths and noses when coughing or sneezing and using antiseptic hand washes.

The organization has also stressed the need for Queenslanders to be vaccinated against the flu, even if they have already endured what they believed to be the virus. He recommends if you have had the flu, to get the vaccine because the vaccine covers multiple strains of viruses that can cause the flu. And unless you have actually had a blood test or swab to figure out exactly which strain of flu you already have, you may get another one.

AMAQ president-elect Richard Kidd said treatments such as Tamiflu were available for patients who went to a GP within 36 to 48 hours of the onset of the flu. Kidd state that influenza symptoms are quite different to common cold, typically there is very high fever, quite often severe headache, aches and pains in the muscles and joints and quite often a very sore throat as well as a runny nose and cough.

The organization recommends that anyone experiencing flu-like symptoms should stay home, as well as avoid using public transport and going to work or school.
(Brisbane Times 6/1/2011)

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Chinese Taipei: Low-path H7N3 avian influenza outbreak
Taiwanese officials said they detected the virus at the farm during intensified surveillance after it turned up on a nearby farm in early April 2011. They confirmed the latest finding on 20 March 2011. The birds appeared healthy. So far the virus has been confirmed in 20 of 1,900 susceptible ducks. More pathogenicity tests are pending.
(CIDRAP 5/30/2011)

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Indonesia: WHO confirms child's H5N1 avian influenza infection
On 3 June 2011 the World Health Organization (WHO) confirmed H5N1 avian influenza in a one-year-old Indonesian girl. Indonesia's health ministry had reported the case earlier this week on its website. The girl, from North Jakarta, got sick on 3 April 2011 and was hospitalized on 8 April 2011. She has recovered. An investigation revealed that, a week before she started having flu symptoms, she had visited a live poultry market with her father, where she handled chickens. The girl's illness pushed Indonesia's H5N1 case total to 178, of which 146 were fatal. The global H5N1 total now stands at 555 cases, including 324 deaths.
(CIDRAP 6/3/2011)

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Viet Nam: H5N1 poultry vaccination halted due to poor match
Viet Nam's government announced on 26 May 2011 that it has stopped its national program to immunize poultry against the H5N1 virus, because a new clade circulating in most of the country is ineffective against the vaccine. Viet Nam's animal health department said the vaccine supplies ordered from China do not work against the new clade, which is circulating in northern, coastal, central, and central highlands areas. The older clade is still circulating in southern provinces. Viet Nam is one of a handful of countries in which H5N1 virus is endemic in poultry. Some endemic countries use the vaccine to contain the virus, but its use is controversial, because asymptomatic infections can spread when vaccination programs aren't adequately monitored.
(CIDRAP 5/27/2011)

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Americas
Canada: Reassortant pandemic H1N1–seasonal H3N2 influenza virus found in toddler
Ontario health officials have identified a reassortant pandemic H1N1–seasonal H3N2 influenza virus collected from an infected toddler, according to ProMED-mail on 9 June 2011. The hybrid virus was recovered from a 16-month-old boy in a Toronto-area hospital who had respiratory and gastrointestinal symptoms but was discharged within 15 hours and recovered uneventfully. Genetic sequencing identified genes of both pandemic 2009 H1N1 and seasonal H3N2 viruses. Craig Pringle, virologist and professor emeritus of the UK's University of Warwick, stated, the occurrence of coinfection is not surprising, but this appears to be the first demonstration of in vivo reassortment. Fortunately the infected child has recovered and the recombinant (reassortant) virus was not transmitted. It remains to be seen whether this or similar reassortants will appear in subsequent epidemics.
(CIDRAP 6/9/2011)

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USA: Experts say influenza shot is best hedge over uncertainty of duration of immunity
The 2011-2012 flu vaccine will contain the same three strains as the 2010-2011 season, which has influenza experts fielding questions about whether currently vaccinated people need to be immunized in the fall of 2011. Experts say vaccine production can drop off quickly for frail and older people, but the scientific data on how long the flu vaccine protects younger healthy populations are unclear. The last time two consecutive flu seasons had a vaccine with the same three strains was between 2002 and 2004. Nancy Cox, MD, who leads the flu division at the US Centers for Disease Control and Prevention (CDC), said that some studies suggest immunity that wanes over time isn't strong enough to protect against flu. CDC officials have suggested that yearly vaccination can provide a hedge against the efficacy of existing vaccines, which is only about 70%, even when the vaccine is a good match with circulating strains. John Treanor, MD, a virologist at the University of Rochester School of Medicine, stated that experts don't have a clear picture of how long flu vaccine protection lasts. The CDC says yearly vaccination will offer the best protection. Flu vaccine manufacturers recently predicted that they will make a record number of doses for the upcoming 2011-2012 season, between 166 million and 173 million.
(CIDRAP 5/27/2011)

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Bolivia: Seven new A/H1N1 pandemic influenza cases
Bolivia's health ministry reported an increase in severe respiratory infections along with seven new 2009 H1N1 infections on 31 May 2011. The country's health minister, Nila Heredia, said respiratory infections have increased along with cold weather affecting La Paz, Oruro, Potosi, and Cochabamba provinces. She ordered Bolivia's health centers to take preventive measures to avoid an increase in 2009 H1N1 infections. The Southern Hemisphere's flu season typically runs from May through October.
(CIDRAP 6/1/2011)

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2. Infectious Disease News

Global
Global: EHEC outbreak update
The outbreak remains primarily centered in Germany, and investigations continue into both the nature of the unusual enteroaggregative verocytotoxin-producing Escherichia coli (EAggEC VTEC) O104:H4 bacterium, which is causing the outbreak, and its source.

Haemolytic uraemic syndrome (HUS)
As of 8 June 2011, Germany had reported 722 HUS cases (including 18 fatalities): 33 more cases (but with no additional deaths) since 7 June 2011. 69% of cases were in females and 88% in adults aged 20 years or older, with the highest attack rates per 100,000 population in the group aged 20–49 years. Case-onset dates ranged from 1 May to 6 June 2011.

Enterohemorrhagic Escherichia coli (EHEC)
As of 8 June 2011, 2,086 cases of EHEC infection (without HUS) had been reported in Germany (eight fatal): 127 more cases and two more deaths since the previous day. 60% of cases were in females and 88% in adults aged 20 years or older. Case-onset dates ranged from 1 May to 6 June 2011.

The Robert Koch Institute, in Germany, states that the current HUS and EHEC notification data, as well as data from the surveillance of bloody diarrhea in emergency departments, show an overall decreasing trend in the number of cases. It is uncertain whether this decline is due to the changing consumption of raw vegetables and/or the waning of the source of infection.

Other countries
As of 8 June 2011, 13 other European countries had reported a total of 35 HUS cases (one fatal) and 61 EHEC cases (none fatal). There were two more HUS cases and three fewer EHEC cases reported since 7 June 2011. As the revised European Union (EU) case definition is being applied, some cases reported earlier have now been excluded. In addition, the Centers for Disease Control and Prevention (CDC) in Atlanta, United States of America have published information on three HUS cases (one confirmed and two suspected) and one suspected EHEC case (without HUS) in the United States linked to this outbreak. On 7 June 2011, the Public Health Agency of Canada reported on one suspected case of E. coli O104 infection (without HUS), in a person with travel history to northern Germany and with links to a confirmed case of E. coli O104 infection in Germany.

All but one of the above HUS and EHEC cases were in people who had travelled to or lived in Germany during the incubation period for infection, typically three to four days after exposure (range: two to ten days). The cause of the outbreak has been proved to be E. coli serotype O104:H4, or more precisely a strain of enteroaggregative verocytotoxin-producing E. coli (EAggEC VTEC) O104:H4. Investigations continue into the source of the outbreak.
(WHO 6/9/2011)

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Europe/Near East
Germany: Source of E. coli outbreak — it was the sprouts after all
German officials announced on Friday, 10 June 2011 that they believe bean sprouts are indeed the source of the deadly E. coli infections in that country, the worst such outbreak in recorded history.

Health authorities had previously fingered the sprouts, grown on an organic farm in Bienenbüttel south of Hamburg, but then retracted their decision when DNA tests comparing strains from infected patients and sprouts on the farm did not match. But now, says Reinhard Burger, head of Germany's disease control agency, the weight of the investigative evidence points to a batch of sprouts grown on that farm.

Mr. Burger said investigators had examined 112 people, 19 of whom had been infected with E. coli during a group visit to a single restaurant, and had examined recipes for the food they had eaten, spoken to the chefs who prepared it and even examined photographs they had taken of one another with their choice of food on the table.

Those in the group who ate sprouts were nine times more likely to be infected than those who didn't, leading investigators to believe sprouts were the source of the E. coli. The researchers traced the sprouts back to the organic farm in Bienenbüttel, and have shut down any further sales of products from the farm. It was the sprouts, Burger said in Berlin. It's likely, however, that the source of the outbreak will never be confirmed with absolute certainty.

The reason the genetic tests were negative may be because the originally contaminated sprouts are no longer available — they may have already been eaten or thrown away. Authorities said the E. coli could have been introduced to the sprouts by people, the water supply or the seeds. Whatever was contaminating the sprouts, public health officials hope, is long gone.

This means that tomatoes, cucumbers and lettuce, which were also initially suspected as possible sources of infection, are exonerated. Germany's disease experts declared these produce safe to eat. They continued to advise people not to eat raw sprouts, however.

So far, 30 people in Germany and one person in Sweden have died from E. coli infection, largely from complications involving hemolytic uremic syndrome, which can cause kidney failure. Nearly 3,000 people have been infected.
(Time 6/10/2011)

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Asia
China: More than 100 children get viral encephalitis
More than 100 children in Fujian province have been infected with viral encephalitis since the beginning of May 2011, local health authorities said Wednesday, 1 June 2011.

Hospitals in Anxi County have reported 200 such cases since 1 June 2011, of which 115 have been confirmed, said Wu Zhengxin, director of the county's health bureau. An investigation by experts from the Ministry of Health and local disease control centers has indicated that the outbreak was caused by ECHO30-type intestinal virus (human echovirus 30), according to Wu.

Infected local children were being treated at Mingxuan Hospital of Anxi County and were in stable condition, Wu said. Another nine children, also from Anxi County, were diagnosed in hospitals in Xiamen city of Fujian and were receiving treatment there, Wu added. The children, all under the age of 12, are from 75 villages of 14 townships in the county.

Children of three to seven years old account for 78% of the total, and 117 children, or 65%, are from the town of Hutou. Local health authorities are closely monitoring the disease to prevent its further spread, Wu said.
(China Daily 6/1/2011)

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New Zealand: Cooling tower suspected in Legionnaires’ outbreak
Steam from a cooling tower is suspected to be behind an outbreak of Legionnaires' disease in the Marlborough region. Nelson Marlborough Public Health Service has tested 19 cooling towers and found one contained the same strain of bacteria that infected three people in April 2011. That is two more cases than are normally reported in the region for the entire year.

Regional medical officer of health Ed Kiddle says the three men worked in the same area as the infected tower; six more people who have symptoms of legionellosis are being tested for the disease. Dr. Kiddle says all the towers have been shock-dosed with chemicals to remove the bacteria and the threat seems to be over.

[ProMED note: The above news release says that one of the 19 cooling towers in the area where the three men worked contained the same "strain" of bacteria that infected the three people in April 2011 but fails to specify whether this determination was based on speciation or actual genotyping of patient isolates and the environmental isolate. Because Legionella may be found in environmental samples without linkage to any cases of legionellosis, the actual causative infectious reservoir should be demonstrated by means of genotyping methods, if possible. If the genotype of clinical and environmental isolates match, this would confirm the cooling tower as the source of the outbreak.]
(ProMED 5/30/2011)

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New Zealand: Measles outbreak hits Auckland
Auckland Regional Public Health Service's Medical Officer of Health Dr. Richard Hoskins has one confirmed measles cases with several more possible cases under investigation the week of 30 May 2011. All are children and the confirmed case attended the 10:50 am screening of 3D Pirates of the Caribbean at St. Lukes Cinemas on Saturday 28 May 2011. Movie goers who attended that session may be at risk of measles infection if they have not been immunized.

Dr. Hoskins advises that measles is highly infectious and makes people very sick. Vaccination is the only protection from this potentially serious disease. This disease spreads easily through the air, especially from coughing and sneezing -- it is highly infectious. It commonly causes ear infections and pneumonia, and may lead to other serious complications and can, in some cases, be fatal. These latest measles cases confirm that measles is still circulating in our communities so it's really important that children are immunized to protect them from needless suffering.
(ProMED 6/6/2011)

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Russia: Five persons infected with brucellosis in the Volgograd region
A total of five people in the settlement Karpovskiy of Gorodishenskiy rayon have been diagnosed with brucellosis at the end of May 2011. Three of them, including a 13-year-old required hospitalization. Currently all of the cases have been discharged. Meanwhile, outbreak control measure like animal culling and disinfection are being taken locally. Last year three similar outbreaks had been registered in the same place. The local state farm is under quarantine since 2010 because of brucellosis. The specialists consider that the infections occur mainly from own animals or due to drinking raw milk. It is strongly recommended not to buy meat and milk from private vendors especially when the veterinary certification cannot be provided.
(ProMED 6/6/2011)

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Russia: Two brucellosis outbreaks in Orenburg
The regional authority for veterinary services has announced about two focuses of brucellosis in the oblast. One is in the village Sagarchinski of Akbulakskiy rayon another is in the village Raznomoyka of Tyulganski rayon. Overall two cows and 60 sheep were found infected. Eleven people also have been diagnosed with brucellosis. Control measures are being taken including destruction of the infected herds. The veterinarians consider that the reason for the infections is non-compliance with veterinarian rules.
(ProMED 6/6/2011)

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Viet Nam: Hand, food and mouth disease in Ho Chi Minh City
Cases of hand, foot and mouth disease (HFMD) increased sharply in Ho Chi Minh City (HCMC) between April and May 2011. Samples from 174 HFMD cases were obtained from Children's Hospitals No. 1 and No. 2 in HCMC and from several southern provinces, including Dong Thap, Dong Nai, Binh Duong and Tien Giang provinces and were tested in the Laboratory of Enteric Viruses of the Pasteur Institute in HCMC. Data from RT-PCR assays showed the presence of human enterovirus 71 (HEV 71) in 43/174 (25%) of cases and other enteroviruses in 91/174 (52%) of cases. HEV 71 was identified in five fatal cases of HFMD from specimens that included CSF and throat swabs.

In nine cases, HEV 71 was isolated in cell culture, and the sub-genotype was identified by nucleotide sequencing. These data showed that eight patients (including two fatal cases from HCMC) were infected with HEV 71 sub-genotype C4, and a single HFMD case from Dong Thap province was infected with HEV71 sub-genotype C5. According to surveillance data obtained from the Pasteur Institute in HCMC, HEV 71 C4 and C5 strains have been prevalent in southern Viet Nam since 2003.
(ProMED 6/7/2011)

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Viet Nam: Quang Ngai reports second death from hand, foot and mouth disease
An infant died from hand, foot and mouth disease (HFMD) in the central Vietnamese province of Quang Ngai on 29 May 2011, the second HFMD fatality in the province in May 2011. The 20-month-old boy died just one day after being admitted to hospital with serious complications.

On 15 May 2011, a 23-month-old boy became the first HFMD death in Quang Ngai in 2011. He was admitted to hospital on 14 May 2011 with high fever, trouble breathing and rash on his palms and legs. Doctors said it was too late to save the boy because he developed fever at home two days before being taken to hospital.

An estimated 200 HFMD cases have been reported in Quang Ngai since early May 2011. The whole country has so far recorded more than 2,000 cases, 96% of which originated from the southern region.
(ProMED 6/4/2011)

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Americas
Chile: Poor air quality exacerbates respiratory syncytial virus outbreak
Cases of respiratory syncytial virus (RSV) infection have appeared earlier in 2011. Since the beginning of May there has been a substantial increase in the number of cases, and during the week of 23 May 2011, reached more than 320 in Santiago. This is close to the peak number of cases observed in 2010, which was in the month of July, that is, a month later.

Poor air quality, accompanied by lack of rain, low temperatures, and poor ventilation in living accommodations, has exacerbated the situation and advanced the onset of seasonal RSV infection in children. Public health clinics are being overburdened by consultations and the more severe cases are causing problems in intensive care units (ICU).

Dr. Jorge Roque, head of the pediatric ICU at the German Clinic, explained that every year we have an outbreak of respiratory syncytial virus infection, but the dates do not always correspond. In May 2011, we are reaching levels very close to what we had in June of 2010, giving the impression that we are in a crisis situation. Probably in one or two weeks we will be at the peak and case numbers will begin to decline, and the RSV season will terminate earlier.

In 2010, there were between 380 or 400 cases whereas the week of 30 May 2011, we have 320 cases already and we are rapidly approaching the peak, which may last a week or two and then begins to decline. During this period we are somewhat stressed, because for example at the German Clinic, nearly half of the 12 beds in the Intensive Care Unit are occupied by children with RSV infection.

One consequence of environmental pollution is that that the air is drier and sudden temperature changes can occur causing hyperactivity, which in children, especially in infants under six months and in children with chronic respiratory diseases like asthma, exacerbates the situation.

Nationally, parainfluenza viruses and adenoviruses are significant causes of respiratory illness in children, but RSV is the main public health problem. Environmental conditions, such as low temperatures and air pollution in Santiago, may trigger outbreaks earlier -- as in 2011 -- and influence the behavior of viruses and infections in general.
(ProMED 6/3/2011)

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USA: Multistate outbreak of human Salmonella Altona infections
CDC is collaborating with public health and agriculture officials in many states and the US Department of Agriculture's (USDA) National Poultry Improvement Plan (NPIP) to investigate a multistate outbreak of human Salmonella serotype Altona infections. As of 25 May 2011, a total of 25 individuals infected with the outbreak strain of Salmonella Altona have been reported from 11 states. The number of ill persons identified in each state is as follows: Indiana (1), Kentucky (3), Maryland (2), Minnesota (1), North Carolina (4), New York (1), Ohio (7), Pennsylvania (2), Tennessee (2), Virginia (1), and Vermont (1).

Among the persons with reported dates available, illnesses began between 25 February 2011 and 25 April 2011. Infected individuals range in age from less than 1-year-old to 84-years-old and the median age is eight years. 52% of patients are male. Among the 21 patients with available information, 8 (38%) were hospitalized. No deaths have been reported.

CDC, in collaboration with many state and local health departments, state departments of agriculture, and USDA-NPIP, is investigating an outbreak of human Salmonella Altona infections linked with contact with chicks and ducklings. Investigators are using the PulseNet system to identify cases of illness that may be part of this outbreak. In PulseNet, the national network of public health and food regulatory agency laboratories coordinated by CDC, DNA is analyzed from bacteria obtained through diagnostic testing of ill people.

In interviews, ill persons answered questions about contact with animals and foods consumed during the week before becoming ill. 16 (76%) of 21 ill persons interviewed reported contact with live poultry (chicks, chickens, ducks, ducklings, geese, and turkeys) prior to becoming ill. Of ill persons who could recall the type of live poultry with which they had contact, all 16 identified chicks, ducklings, or both, and 14 (88%) reported purchasing chicks and ducklings from multiple locations of a nationwide agriculture feed store, Feed Store Chain A. Ill persons report purchasing live poultry for either backyard flocks to produce eggs or as pets.

In May 2011, laboratory testing yielded Salmonella Altona bacteria from three samples from a chick and its environment collected from an ill person's household in Ohio, and three environmental samples collected from chick and duckling displays at two locations of Feed Store Chain A in North Carolina.

Findings of multiple traceback investigations of live chicks and ducklings from homes of ill persons have identified a single mail-order hatchery as the source of these chicks and ducklings.
(CDC 5/27/2011)

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USA (New Mexico): Second case of bubonic plague in 2011
Rodent-related diseases are making themselves known in 2011 in the “Land of Enchantment” with cases of hantavirus and plague finding their way into the human population.

The latest is the second case of bubonic plague reported by the New Mexico Department of Health on Friday 27 May 2011. The patient is a 78-year-old man from Santa Fe County who is recovering in the hospital.

New Mexico Health Secretary Dr. Catherine Torres warns that health officials are seeing plague activity in both humans and animals in parts of north-central New Mexico and precautions need to be taken to avoid rodents and their fleas.
(ProMED 5/3/2011)

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USA (Colorado): Two dead from outbreak of Listeria
The Colorado Department of Public Health and Environment (CDPHE) says two people have died because of an outbreak of listeriosis. The CDPHE says it is working with Denver Public Health and Denver Environmental Health after three cases of listeriosis were reported since 20 May 2011. All three cases involved people of Hispanic or Latino heritage, according to the CDPHE. The two people who died were a man in his 30s and a woman in her 60s.

These cases are very concerning to us because we have seen three in over a little more than a week, and usually we see only ten cases a year. So this is very concerning to us, Alicia Cronquist, an epidemiologist, said. The CDPHE says Colorado averages ten cases of listeriosis a year. The source of the outbreak is still unknown.

People who are at high risk for Listeria infection include people with weakened immune systems from transplants or certain chronic diseases, immunosuppressive therapies or medications; pregnant women; and people age 60 and older. Healthy people rarely contract listeriosis, according to the CDPHE.
(ProMED 6/5/2011)

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USA (New Mexico): State investigates measles case in Otero County
The New Mexico Department of Health is investigating a case of measles in Otero County. The department's scientific laboratory division says it has confirmed a case in a 14-month-old boy who recently traveled in Europe. The boy is reportedly recovering at home. This is the second measles case in New Mexico in 2011. The first case was found in a 27-year-old woman from Santa Fe County.

Our staff is working closely with the family and the Centers for Disease Control and Prevention to identify other people who may have been exposed to the disease so we can prevent more cases, said Dr. Catherine Torres, the Department of Health's cabinet secretary. Patients with measles serve as a reminder to all of us to keep immunizations current.

The Department of Health recommends that people traveling outside of the country check that they are current on all immunizations, including the measles vaccination. Vaccines are free for any child in New Mexico, regardless of insurance status, under the Vaccines for Children program. Children who have no insurance coverage can get the vaccine at their local public health department.
(Alamogordo Daily News 5/29/2011)

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USA (Utah): Cache County child has confirmed case of measles
A school-age child in Cache County has measles, health officials at the Bear River Health Department said Tuesday 31 May 2011, the first confirmed case in the county in many years. Officials do not yet know how the child caught the highly contagious virus.

It's possible the child caught measles from an undetected case related to Salt Lake County's recent outbreak, but the exact source may never be known, said Lloyd Berentzen, executive director of Bear River Health Department. The child has had no known exposure other than being in Salt Lake during the outbreak there. About 15 people -- including unvaccinated students at the child's school, which ends classes on Thursday 2 June 2011 -- have been asked to self-quarantine for an indefinite period of time, Berentzen said.

In Salt Lake County, officials on 17 May 2011 declared a recent nine-person outbreak over, after a 28-day quarantine period concluded with no new cases. That outbreak started with the unimmunized children in one family who traveled to Poland to retrieve a missionary.

The child in Cache County is believed to have been exposed on 13 May 2011, an estimate based on when the child started showing symptoms, said Berentzen. The child had not been vaccinated.
(Salt Lake Tribune 5/31/2011)

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3. Updates
INFLUENZA A/H1N1
- WHO
Influenza A/H1N1: http://www.who.int/csr/disease/swineflu/en/index.html
Influenza A/H1N1 frequently asked questions:
http://www.who.int/csr/disease/swineflu/frequently_asked_questions/en/index.html
Pandemic Influenza Preparedness and Response - A WHO Guidance Document
http://www.who.int/csr/disease/influenza/pipguidance2009/en/index.html
International Health Regulations (IHR) at http://www.who.int/ihr/en/index.html.

- WHO regional offices
Africa: http://www.afro.who.int/
Americas: http://new.paho.org/hq/index.php?option=com_content&task=blogcategory&id=805&Itemid=569
Eastern Mediterranean: http://www.emro.who.int/csr/h1n1/
Europe: http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/influenza/pandemic-influenza
South-East: http://www.searo.who.int/EN/Section10/Section2562.htm
Western Pacific: http://www.wpro.who.int/health_topics/h1n1/

- North America
US CDC: http://www.cdc.gov/flu/swine/investigation.htm
US pandemic emergency plan: http://www.flu.gov
MOH México: http://portal.salud.gob.mx/index_eng.html
PHA of Canada: http://fightflu.ca

- Other useful sources
CIDRAP: Influenza A/H1N1 page:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/biofacts/swinefluoverview.html
ProMED: http://www.promedmail.org/
WHO H1N1 pandemic influenza update 115: http://www.who.int/csr/don/2010_08_27/en/index.html
CDC Teleconference results: Healthcare groups need to share emergency plans:
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/sep0210standards.html
American Academy of Pediatrics Policy Statement: Recommendations for Prevention and Control of Influenza in Children, 2010-2011: >http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-2216v1

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AVIAN INFLUENZA
- UN: http://www.undp.org/mdtf/influenza/overview.shtml UNDP’s web site for information on fund management and administrative services. This site also includes a list of useful links.
- WHO: http://www.who.int/csr/disease/avian_influenza/en/
- UN FAO: http://www.fao.org/avianflu/en/index.html. View the latest avian influenza outbreak maps, upcoming events, and key documents on avian influenza H5N1.
- OIE: http://www.oie.int/eng/info_ev/en_AI_avianinfluenza.htm. Link to the Communication Portal gives latest facts, updates, timeline, and more.
- US CDC: Visit "Pandemic Influenza Preparedness Tools for Professionals" at: http://www.cdc.gov/flu/pandemic/preparednesstools.htm. This site contains resources to help health officials prepare for an influenza pandemic.
- The US government’s website for pandemic/avian flu: http://www.flu.gov/. “Flu Essentials” are available in multiple languages.
- CIDRAP: Avian Influenza page: http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/.
- PAHO: http://www.paho.org/English/AD/DPC/CD/influenza.htm.
- Link to the Avian Influenza Portal at: http://influenza.bvsalud.org/php/index.php?lang=en. The Virtual Health Library’s Portal is a developing project for the operation of product networks and information services related to avian influenza.
- US National Wildlife Health Center: http://www.nwhc.usgs.gov/disease_information/avian_influenza/index.jsp Read about the latest news on avian influenza H5N1 in wild birds and poultry.

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VECTOR-BORNE DISEASE
Russia
The regional office of Rospotrebnadzor (Federal Service for Consumer Protection and Human Welfare) has published the recent epidemiological data on tick bites, tick infection rates, and tick-borne borreliosis (Lyme disease) cases in the region Nizhny Novgorod.

There were 2,722 cases of tick bites in the region during April 2011, and 1,004 people have sought medical help after tick bites. As of 2 June 2011, there have been five tick-borne borreliosis (Lyme disease) cases. In 23 ticks that were tested, the antigens of Borrelia burgdorferi were detected (1.7% of all tested ticks). Rospotrebnadzor urges the population to seek medical help after tick bites and bring the ticks, which will be tested free of charge.
(ProMED 6/8/2011)


Viet Nam (Dong Nai)
More than 1,100 dengue cases with three deaths have been reported across Dong Nai province since the beginning of 2011, director of the Provincial Preventive Medicine Centre Cao Trong Nguong said. The figure represents a year-on-year increase of almost 70%. The deaths were reported in Bien Hoa city, Dinh Quan, and Thong Nhat districts. Bien Hoa city saw the highest number of cases and the city reported nearly 50% of all dengue cases recorded province-wide.
(ProMED 6/6/2011)

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4. Articles
Racial and Ethnic Disparities in Uptake and Location of Vaccination for 2009-H1N1 and Seasonal Influenza
Uscher-Pines L, Maurer J, Harris KM. Am J of Public Health. July 2011; 101 (7):1252-1255. doi: 10.2105/AJPH.2011.300133.
Available at http://ajph.aphapublications.org/cgi/content/short/101/7/1252

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.

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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 Infect Dis. 15 June 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¨C2008. We used Poisson regression models that included environmental and seasonal variables to investigate the relationship between influenza and MI.

Results. There were ¡Ý1.2 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%¨C3.4% of MI-associated deaths (P < .001) and 0.7%¨C1.2% of MI-associated hospitalizations (P < .001) were attributable to influenza, and in Hong Kong, where the corresponding figures were 3.9%¨C5.6% (P = .018) and 3.0%¨C3.3% (P = .002).

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

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Different Immune Responses to Three Different Vaccines following H6N1 Low Pathogenic Avian Influenza Virus Challenge in Taiwanese Local Chicken Breeds
Chang CS, Tixier-Boichard M, Chazara O. BMC Proc. 3 June 2011; 5 Suppl 4:S33.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21645314

Background. H6N1 low pathogenic avian influenza virus (LPAIV) are frequently isolated in Taiwan and lead to significant economic losses, either directly or indirectly through association with other infectious diseases. This study investigates immune responses to three different vaccines following a H6N1 challenge in different local breeds.

Methods. Experimental animals were sampled from six local chicken breeds maintained at the National Chung-Hsing University, namely Hsin-Yi, Ju-Chi, Hua-Tung (Taiwan), Quemoy (Quemoy Island), Shek-Ki (China), Nagoya (Japan) and a specific pathogen free (SPF) White Leghorn line. A total number of 338 chickens have been distributed between a control and a challenge group, H6N1 challenge was performed at 7 weeks of age; vaccination against Newcastle Disease (ND), Infectious Bursal Disease (IBD) and Infectious Bronchitis (IB) was performed at 11 weeks. The anti-H6N1 LPAIV antibody titers were measured by ELISA at days 0, 7, 14 and 21 after challenge, and the anti-ND, anti-IBD and anti-IB antibody titers were measured by inhibition of hemagglutination test and ELISA at days 0, 14, 28 after vaccination.

Results. There was no effect of the H6N1 LPAIV challenge at 7 weeks of age on the subsequent responses to ND and IBD vaccine at 11 weeks of age, but, surprisingly, the H6N1 LPAIV challenge significantly affected antibody levels to IB vaccine in some breeds, since IB0 and IB14 antibody titers were lower in the challenge groups. However, there was no significant difference in IB28 antibody titers among the experimental groups.

Conclusions. Local breeds have different immune response to H6N1 LPAIV challenge and subsequent vaccines. Differences dealt mainly with kinetics of response and with peak values. Quemoy exhibited higher antibody levels to H6N1, ND and IBD. The negative effect of the H6N1 LPAIV challenge on IB vaccine response may be related to the fact that both viruses target the lung tissues, and the type of local immune response induced by LPAIV challenge may not be favorable for birds to make optimum IB-specific antibody response.

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Recent Progress of Shiga Toxin Neutralizer for Treatment of Infections by Shiga Toxin-Producing Escherichia coli
Nishikawa K. Arch Immunol Ther Exp (Warsz). 5 June 2011. (Epub ahead of print).
Available at http://www.ncbi.nlm.nih.gov/pubmed/21644029

Abstract. Infection with Shiga toxin (Stx)-producing Escherichia coli (STEC), including O157:H7, causes bloody diarrhea and hemorrhagic colitis in humans, occasionally resulting in fatal systemic complications, such as neurological damage and hemolytic-uremic syndrome. Because Stx is a major virulence factor of the infectious disease, a series of Shiga toxin neutralizers with various structural characteristics has been developed as promising therapeutic agents. Most of these agents function to bind to the toxin directly and inhibit the binding to its receptor present on the target cells. Other neutralizers do not inhibit receptor binding but induce aberrant intracellular transport of the toxin, resulting in effective detoxification. Such a novel type of Stx neutralizer provides a new therapeutic strategy against STEC infections. Here, recent progress of the development of Stx neutralizers is reviewed.

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The Aftermath of the Western Australian Melioidosis Outbreak
Inglis TJ, O'Reilly L, Merritt AJ. Am J Trop Med Hyg. June 2011; 84(6):851-857.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21633018

Abstract. Melioidosis became a notifiable disease in Western Australia (WA) 2 years after the West Kimberley melioidosis outbreak. Two cases of melioidosis caused by the outbreak genotype of Burkholderia pseudomallei (National Collection of Type Cultures [NCTC] 13177) occurred in 1998 and 1999 in persons who visited the outbreak location at the time. No other infections caused by the outbreak strain have been recorded in WA since that time, despite an average of four culture-positive cases per year. Sporadic cases of melioidosis often follow tropical storms and cyclones during summer, and they have been detected outside the endemic area when cyclones travel far inland. In 2007, environmental isolates resembling NCTC 13177 were found 500 km east of the outbreak location after unusually severe weather. Recent whole-genome analysis places NCTC 13177 genetically close to other Australian isolates. Additional biogeographic and ecological studies are needed to establish the relative importance of environmental cofactors in disease pathogenesis.

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Sex Differences in the Incidence and Case Fatality Rates from Hemorrhagic Fever with Renal Syndrome in China, 2004-2008
Klein SL, Marks MA, Li W. Clin Infect Dis. June 2011; 52(12):1414-21.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21628481

Background. Differences between male and female individuals in response to infectious diseases are an overlooked global health problem.

Methods. The relationship between sex and disease outcome was examined in populations of patients with hemorrhagic fever with renal syndrome (HFRS) in mainland China, where most cases of hantavirus exposure occur. HFRS in China is diagnosed on the basis of symptoms and is confirmed with serological testing. The geographical distribution, incidence, and case fatality rates (CFRs) of HFRS in China were estimated and compared by patient sex and age. In a subset of patients with HFRS, clinical manifestations of HFRS were assessed using latent class analysis and compared by sex.

Results. There were 80,671 HFRS cases reported during the period 2004-2008, with a majority of HFRS cases (39.2%) occurring among individuals 20-39 years of age. The incidence of HFRS was higher among male patients than among female patients for all individuals >10 years of age. There were 945 deaths (CFR, 1.17%) due to HFRS in China during the period 2004-2008. CFRs were higher among women than among men between the ages of 20-39 and ¡Ý50 years of age. There were no sex differences in the geographical distribution of HFRS cases or deaths. Although the prevalence of each clinical marker did not differ by sex, 2 profiles of clinical markers were identified that were related to both severity of disease and sex.

Conclusions. These data illustrate a paradox in which the incidence of disease is greater for males, but the severity of disease outcome is worse for females. Several behavioral, societal, and biological factors are hypothesized to be involved.

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Global Health Education Consortium: 20 Years of Leadership in Global Health and Global Health Education
Velji A. Infect Dis Clin North Am. June 2011; 25(2):323-35.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21628048

Abstract. The Global Health Education Consortium (GHEC) is a group of universities and institutions committed to improving the health and human rights of underserved populations worldwide through improved education and training of the global health workforce. In the early 1990s, GHEC brought together many of the global health programs in North America to improve competencies and curricula in global health as well as to involve member institutions in health policy, development issues, and delivery of care in the inner cities, marginalized areas, and abroad.

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Global Health: the Twenty-First Century Global Health Priority Agenda
Alleyne GA. Infect Dis Clin North Am. June 2011; 25(2):295-7. (Epub 15 April 2011).
Available at http://www.ncbi.nlm.nih.gov/pubmed/21628045

Abstract. Growth in global health interest in the past 20 years has been overwhelming and many universities throughout the world have created departments or institutes of global health. The essence of global health has to be promoting health equity globally. The global health agenda must embrace design of mixed health systems, involving both private and public components to address the emerging threat of noncommunicable diseases and existing communicable diseases as well as to reduce health inequity. The priority agenda for the twenty-first century is challenging but the improvements of the past give hope that the barriers to improving global health are surmountable.

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Current and Nano-Diagnostic Tools for Dengue Infection
Peh EK, Leo YS, Toh CS. Front Biosci (Schol Ed). 1 June 2011; 3:806-21.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21622234

Abstract. Dengue is one of the infectious diseases that is widespread over global regions with yearly occurrence of epidemics and could be deadly in some cases. Thus the developments of rapid and specific diagnostic tools which can achieve early detection of dengue infection for disease control during epidemic situations and before complications occur are deemed highly desirable. This paper describes the current and advanced methods for diagnosis of dengue infection and discusses the advantages and disadvantages of these methods in terms of their analytical performances and clinical applicabilities. The current methods discussed herein include enzyme-linked immunosorbent assay and reverse transcriptase polymerase chain reaction. In addition, recent instrumental methods such as quartz crystal microbalance, surface plasmon resonance, photonic crystal and electrochemical impedance spectroscopy have shown promising results. Interesting developments in detection of dengue infection using nanosized materials including liposomes, nanowires and nanopores, coupled to conventional fluorescence, potentiometry and voltammetry methods are also described and could possibly point the way forward for the development of inexpensive diagnostic tools for use at point-of-care and in events of epidemic scale.

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Review: Genetics of Infectious Diseases: Hidden Etiologies and Common Pathways
Orlova M, Di Pietrantonio T, Schurr E. Clin Chem Lab Med. 27 May 2011 (Epub ahead of print).
Available at http://www.ncbi.nlm.nih.gov/pubmed/21619464

Abstract. Since the completion of the human genome sequence, the study of common genetic polymorphisms in complex human diseases has become a main activity of human genetics. Employing genome-wide association studies, hundreds of modest genetic risk factors have been identified. In infectious diseases the identification of common risk factors has been varied and as in other common diseases it seems likely that important genetic risk factors remain to be discovered. Nevertheless, the identification of disease-specific genetic risk factors revealed an unexpected overlap in susceptibility genes of diverse inflammatory and infectious diseases. Analysis of the multi-disease susceptibility genes has allowed the definition of shared key pathways of inflammatory dysregulation and suggested unexpected infectious etiologies for other "non-infectious" common diseases.

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Review of Cases with the Emerging Fifth Human Malaria Parasite, Plasmodium knowlesi
Kantele A, Jokiranta TS. Clin Infect Dis. June 2011; 52(11):1356-62.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21596677

Abstract. Human malaria has been known to be caused by 4 Plasmodium species, with Plasmodium falciparum causing the most-severe disease. Recently, numerous reports have described human malaria caused by a fifth Plasmodium species, Plasmodium knowlesi, which usually infects macaque monkeys. Hundreds of human cases have been reported from Malaysia, several cases have been reported in other Southeast Asian countries, and a few cases have been reported in travelers visiting these areas. Similarly to P. falciparum, P. knowlesi can cause severe and even fatal cases of disease that are more severe than those caused by the other Plasmodium species. Polymerase chain reaction is of value for diagnosis because P. knowlesi infection is easily misdiagnosed as less dangerous Plasmodium malariae infection with conventional microscopy. P. knowlesi infection should be suspected in patients who are infected with malaria in Southeast Asia. If human-mosquito-human transmission were to occur, the disease could spread to new areas where the mosquito vectors live, such as the popular tourist areas in western India.

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Health Care-Associated Measles Outbreak in the United States after an Importation: Challenges and Economic Impact
Chen SY, Anderson S, Kutty PK. J Infect Dis. June 2011; 203(11):1517-25 (Epub 28 April 2011).
Available at http://www.ncbi.nlm.nih.gov/pubmed/21531693

Background. On 12 February 2008, an infected Swiss traveler visited hospital A in Tucson, Arizona, and initiated a predominantly health care-associated measles outbreak involving 14 cases. We investigated risk factors that might have contributed to health care-associated transmission and assessed outbreak-associated hospital costs.

Methods. Epidemiologic data were obtained by case interviews and review of medical records. Health care personnel (HCP) immunization records were reviewed to identify non-measles-immune HCP. Outbreak-associated costs were estimated from 2 hospitals.

Results. Of 14 patients with confirmed cases, 7 (50%) were aged ¡Ý18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent US$799,136 responding to and containing 7 cases in these facilities.

Conclusions. Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care-associated spread and in minimizing hospital outbreak-response costs.

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Viral Etiology of Acute Lower Respiratory Tract Infections in Hospitalized Young Children in Northern Taiwan
Sung CC, Chi H, Chiu NC. J Microbiol Immunol Infect. June 2011; 44(3):184-90 (Epub 18 June 2011).
Available at http://www.ncbi.nlm.nih.gov/pubmed/21524612

Background. Lower respiratory tract infections (LRTIs) comprise a great proportion of diagnoses among hospitalized children. This study identifies the viral pathogens causing LRTIs in young children and compares their clinical features and disease severity.

Methods. Children younger than 36 months old, hospitalized at a medical center in Northern Taiwan with acute bronchiolitis or pneumonia from April to December 2007, were prospectively enrolled. Nasopharyngeal aspiration fluid samples were sent for virus culture, for direct immunofluorescence test of respiratory syncytial virus (RSV), for rapid influenza viral identification, and for polymerase chain reaction of human metapneumovirus (hMPV), human boca virus (hBoV), and human corona virus. The clinical features and laboratory findings were recorded and analyzed.

Results. A total of 48 children were enrolled. RSV was the most common pathogen (41.7%), followed by hMPV (27.1%), hBoV, and enterovirus (both 6.3%). There were no significant differences in clinical presentation and disease severity between the RSV and hMPV groups. However, the hMPV group had a higher mixed infection rate (p = 0.038). Fourteen children had no identifiable viruses. Children with single, dual, and triple pathogens numbered 26, 7, and 1, respectively. The mixed infection rate reached 23.5% among 34 children with identifiable viruses. Children with a higher severity score had greater chance to develop asthma in the next 2 years (p = 0.042).

Conclusion. RSV is the most common pathogen causing LRTIs in young children, followed by hMPV. The hMPV group had higher mixed infection rate than RSV group. hBoV does circulate in northern Taiwan.

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The Virology, Epidemiology, and Clinical Impact of West Nile Virus: a Decade of Advancements in Research since Its Introduction into the Western Hemisphere
Murray KO, Walker C, Gould E. Epidemiol Infect. 1 June 2011; 139(6):807-17 (Epub 23 February 2011).
Available at http://www.ncbi.nlm.nih.gov/pubmed/21342610

Abstract. West Nile virus (WNV) is now endemic in the USA. After the widespread surge of virus activity across the USA, research has flourished, and our knowledge base has significantly expanded over the past 10 years since WNV was first recognized in New York City. This article provides a review of the virology of WNV, history, epidemiology, clinical features, pathology of infection, the innate and adaptive immune response, host risk factors for developing severe disease, clinical sequel following severe disease, chronic infection, and the future of prevention.

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Clinical Significance of Nontuberculous Mycobacteria Isolates in Elderly Taiwanese Patients
Lai CC, Tan CK, Lin SH. Eur J Clin Microbiol Infect Dis. June 2011; 30(6):779-83 (Epub 16 June 2011).
Available at http://www.ncbi.nlm.nih.gov/pubmed/21240651

Abstract. The aim of this study was to investigate the clinical significance of nontuberculous mycobacteria (NTM) isolates in elderly Taiwanese patients. From 2004 through 2008, patients >65 years old with NTM isolation were identified. The definitions of NTM disease followed the American Thoracic Society and Infectious Disease Society of America (ATS/IDSA) criteria. Among the 3,175 NTM isolates, Mycobacterium avium complex (MAC; n = 1,118, 35.2%) was the most prevalent species, followed by M. abscessus (n = 545, 17.2%). Among the 1,633 elderly patients with NTM isolates, the most prevalent NTM species were MAC (n = 592, 36.3%) and M. fortuitum complex (n = 311, 19.0%). NTM colonization was found in 1,339 (80.4%) patients and only 326 (19.6%) patients had NTM diseases. During the study period, the annual incidence rates (per 100,000 inpatients and outpatients) of NTM colonization and disease both increased significantly (p < 0.0001) from 10.5 to 15.8 and from 2.1 to 4.3, respectively. Isolated pulmonary NTM infections compromised 294 (90.2%) of the 326 elderly cases of NTM disease. In conclusion, this study found an increasing trend in the incidence of both NTM isolates and NTM diseases among elderly Taiwanese patients. MAC and M. abscessus were the most frequent species causing various types of NTM disease.

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Pandemic Response Lessons from Influenza H1N1 2009 in Asia
Fisher D, Hui D, Gao Z. Respirology. 31 May 2011. doi: 10.1111/j.1440-1843.2011.02003.x (Epub ahead of print).
Available at http://www.ncbi.nlm.nih.gov/pubmed/21627715

Abstract. During April 2009, a novel H1N1 influenza A virus strain was identified in Mexico and the United States of America. Within weeks the virus had spread globally and the first pandemic of the 21(st) Century had been declared. It is unlikely to be the last and it is crucial that real lessons are learned from the experience. Asia is considered a hot spot for the emergence of new pathogens including past influenza pandemics. On this occasion whilst preparing for an avian, highly virulent influenza virus (H5N1 like) originating in Asia in fact the pandemic originated from swine, and was less virulent. This discrepancy between what was planned for and what emerged created its own challenges. The H1N1 pandemic has tested national healthcare infrastructures and exposed shortcomings in our preparedness as a region. Key health challenges include communication throughout the region, surge capacity, access to reliable information and access to quality care, health care worker skills, quality, density and distribution, access to essential medicines and lack of organizational infrastructure for emergency response. Despite years of preparation the public health and clinical research community were not ready to respond and opportunities for an immediate research response were missed. Despite warm words and pledges efforts to engage the international community to ensure equitable sharing of limited resources such as antivirals and vaccines fell short and stockpiles in the main remained in the rich world. This manuscript with authors from across the region describes some of the major challenges faced by Asia in response to the pandemic and draws lessons for the future.

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5. Notifications
Radio panel discussion on Europe E. coli outbreak
The Today show on CRI will be holding a radio panel discussion about the recent outbreak of E. coli cases throughout Europe and will be looking at the health/medical impacts of E. coli in humans. Methods for future prevention of E. coli in the EU and other countries will also be discussed.

Date: 13 June 2011, 10am-11am Beijing time (12 June 2011, 10pm-11pm US Eastern time).
Frequency: Live on AM846, Beijing; FM88.0, Canberra, Australia; AM880, Hawaii, AM570, North California and AM1320, Galveston, TX, USA. The show will also be re-broadcast on CRI relay stations worldwide (http://english.cri.cn/cribb/programs/today.htm).

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Global to Local: Implementing the International Health Regulations (2005)
The Global Health Security program at the Stimson Center is pleased to announce our updated “one stop shop” for information on the International Health Regulations (2005). Our constantly growing website has over 175 publications relating to issues surrounding the IHR (2005), including disease surveillance, capacity building, implementation, legal issues, health diplomacy, influenza, and many others. In addition to a searchable database, the website includes WHO guidance and current news and events relating to the IHR (2005), capacity building and other related topics. The site also includes original briefing materials on disease surveillance and the implications of the IHR (2005) for US decision-makers, including our recently released issue brief "Surveillance and Response in an Era of Globalization - http://cts.vresp.com/c/?TheHenryL.StimsonCen/bfd9f54d07/6ee1aa25a7/a59d3e19b8
Additional information at http://www.stimson.org/IHR

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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/

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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/

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Influenza 2011: Zoonotic Influenza and Human Health
Oxford, England, United Kingdom, 7-9 September 2011
The 4th Oxford influenza conference, Influenza 2011, will address most aspects of basic and applied research on zoonotic influenza viruses and their medical and socio-economic impact, and invites proposals for podium and poster sessions in the following general areas: epidemiology and evolution; molecular virology and immunology; host-pathogen interaction - virulence and pathogenicity; mathematical models; national and international surveillance and contingency strategies; antiviral drug development and treatment strategies, including vaccination; and advances in viral detection and identification technologies.
Additional information at http://www.libpubmedia.co.uk/Conferences/Influenza2011/Influenza2011%20Home.htm

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 apecein@u.washington.edu