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Vol. XIV No. 14 ~ EINet News Briefs ~ Jul 08, 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: Lessons from European pandemic surveillance
- Global: Influenza season starting in Southern Hemisphere
- Germany: H7N7 avian influenza turns up on more farms
- South Africa: Ostrich farmers seek disaster declaration for H5N2 avian influenza toll

2. Infectious Disease News
- Global: Update on European E. coli outbreak
- Global: Fenugreek seed tracing
- Australia: Fears for 23 people after Hendra virus goes undetected for two weeks
- Australia: First case of gnathostomiasis reported in the country
- Hong Kong: Mutated scarlet fever fuels outbreak
- New Zealand: Measles cases escalate in Auckland
- New Zealand: Measles outbreak continues in Hawke’s Bay
- Philippines: Measles cases in Capiz on the rise
- Russia (Udmurtia): Hemorrhagic fever with renal syndrome
- Russia: Swine fever may hit
- Viet Nam: More than 45,000 animals die of foot-and-mouth disease
- Canada: Bovine tuberculosis on Cherryville farm
- Chile: New cases of respiratory syncytial virus infection in children
- USA: High number of reported measles cases in 2011 -- linked to outbreaks abroad
- USA: Multistate outbreak of human Salmonella enterica infections linked to alfalfa sprouts and spicy sprouts
- USA (Alabama): E. coli outbreak at water park

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

4. Articles
- Rural–Urban Differences in the Location of Influenza Vaccine Administration
- The Geographic Synchrony of Seasonal Influenza: A Waves across Canada and the United States
- Escherichia coli O104:H4 from 2011 European Outbreak and Strain from Republic of Korea
- Development and Validation of an Instrument to Assess the Risk of Developing Viral Infections in Australian Travelers During International Travel
- Clostridium difficile Laboratory Testing in Australia and New Zealand: National Survey Results and Australasian Society for Infectious Diseases Recommendations for Best Practice
- Virological Surveillance of Human Influenza in Indonesia, October 2008-March 2010
- Outbreak of Measles in the Republic of Korea, 2007: Importance of Nosocomial Transmission
- Epidemiology of a Measles Epidemic in Vietnam 2008-2010
- Progress and Challenges for Measles Elimination by 2012 in the Western Pacific Region
- Deaths Associated With Bacterial Pathogens Transmitted Commonly Through Food: Foodborne Diseases Active Surveillance Network (FoodNet), 1996-2005

5. Notifications
- 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 / 6 (6)
Egypt / 31 (12)
Indonesia / 7 (5)
Total / 46 (23)

***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: 562 (329) (WHO 6/22/2011)
http://www.who.int/csr/disease/avian_influenza/country/cases_table_2011_06_22/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 5/2/11):
http://www.who.int/csr/disease/avian_influenza/H5N1_avian_influenza_update.pdf

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Global: Lessons from European pandemic surveillance
A review of surveillance systems used during the 2009 H1N1 pandemic in 27 European countries found that the systems were resilient and useful, but some countries' systems had a hard time capturing data on severe respiratory infections. The findings were published 29 June 2011 in Eurosurveillance. The authors, from the European Centre for Disease Prevention and Control (ECDC), wrote that systems for tracking severe cases and deaths in many cases were introduced during the pandemic, which they said isn't the best time to launch a new system, because resources are stretched. The group also noted that systems for sharing information from the first affected countries could be improved by protecting the security and confidentiality of the communication systems. They also suggested that revised pandemic plans include more seroprevalence studies to provide better information in real time. In an accompanying editorial, two public health experts, Dr. Heath Kelly of the Victoria Infectious Disease Reference Laboratory in Australia and Dr Benjamin Cowling of Hong Kong University, said early estimates of the reproductive number in the United Kingdom may have been too high, for several reasons. Counting imported cases as locally acquired cases and selection bias could have led to overestimates, they noted. Also, the early estimates included a high proportion of infections in school-age children, a group that had a higher reproductive number than the general population. Another factor that could have led to overestimates was unrecognized transmission that occurred prior to testing. The two experts voiced support for the ECDC authors' surveillance suggestions and said the improvements should e addressed before the next pandemic strikes.
(CIDRAP 6/30/2011)

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Global: Influenza season starting in Southern Hemisphere
The 2011 influenza season is starting in at least one part of the Southern Hemisphere. Reports from South Africa note high flu activity, with more than 80% of cases from 24 June 2011 to 1 July 2011 caused by the 2009 H1N1 virus and increasing levels of type B flu. Flu activity in New Zealand is low, as it is in much of Australia, but a recent increase in emergency department visits for influenza-like illness may indicate the beginning of the flu season there as well. Elsewhere, pockets of flu transmission exist in South America, sub-Saharan Africa, and tropical Asia. In the Dominican Republic, 2009 H1N1 flu levels have increased from 17 June 2011 to 1 July 2011, and in Bolivia, the incidence of H3N2 flu has increased since May 2011, now accounting for about 20% of clinical specimens tested. In West Africa, influenza B is showing moderate activity in Mali, Ghana, Togo, Nigeria, and Cameroon. Flu activity in the United States was at a typically low summer level on 24 June 2011, with only 1% of visits to sentinel medical providers attributed to flu-like illness. The national baseline cited by the CDC is 2.5% of visits.
(CIDRAP 7/1/2011)

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Europe/Near East
Germany: H7N7 avian influenza turns up on more farms
Animal health officials in Germany on 29 June 2011 reported six more low-pathogenic H7N7 avian influenza outbreaks, according to a report to the World Organization for Animal Health (OIE). They occurred at four farms in Saxony state and two farms in North Rhine-Westphalia state. In total the outbreaks sickened 20 birds, killed one, and led to the culling of 27,337. The most recent round of H7N7 outbreaks began in May 2011 and has so far affected 16 farms.
(CIDRAP 6/30/2011)

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Africa
South Africa: Ostrich farmers seek disaster declaration for H5N2 avian influenza toll
Ostrich farmers from South Africa's Western Cape were expected to meet with government officials on 29 June 2011 to discuss the possibility of a national disaster declaration because of highly pathogenic H5N2 avian influenza outbreaks that have decimated the local industry. So far more than 23,000 birds have been culled, and ostrich meat from the area has been banned. State veterinarians are conducting another round of surveillance for the disease to assess the current status. Since mid April 2011 the country has reported 21 H5N2 outbreaks to the World Organization for Animal Health (OIE).
(CIDRAP 6/29/2011)

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2. Infectious Disease News

Global
Global: Update on European E. coli outbreak
In the EU/EEA, 897 HUS cases, including 33 deaths, and 3,314 non-HUS cases, including 17 deaths, have been reported as of 4 July 2011.

Since the last update, Germany reports six additional HUS cases and one new HUS fatality, as well as 33 additional non-HUS STEC cases. Three HUS cases and 11 non-HUS STEC cases fell ill between 25 June and 4 July 2011. The last known date of illness onset in a patient with confirmed STEC O104 was 26 June 2011. The last reported date of illness onset among all cases (also without O104 confirmation) was 29 June 2011.

With regards to the outbreak in France (Bordeaux Region), eight cases of bloody diarrhea and a further seven HUS cases have been identified as of 2 July 2011. Infection with E. coli O104:H4 has been confirmed for six patients with HUS. 11 of the patients had attended an event in Begles: Seven women and four men, between 31 and 64 years of age. Ten of these 11 reported having eaten sprouts. One previously identified case of HUS, who had no link to the event in Begles, has been removed from our counts, as she tested positive for E. coli serogroup O145 and not for O104.

Thorough investigations are ongoing. Strains from three patients tested by the French authorities were compared to strains from patients linked to the outbreak in Germany. The comparison showed that the two strains were indistinguishable. This suggests that these two events are related to a common source.
(ECDC 7/5/2011)

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Global: Fenugreek seed tracing
The comparison of the back tracing information from the French and German outbreaks leads to the conclusion that a lot (no 48088) of fenugreek seeds imported from Egypt, is the most likely common link, although it cannot be excluded that other lots coming through the same production/supply chain may be implicated.

Given the possible severe health impact of exposure to a small quantity of contaminated material, and, in the absence of information regarding the source and means of contamination and possible cross contamination, it seems appropriate to consider all lots of fenugreek for the period 2009-2011 from the identified exporter as suspect. In this regard, the thus far negative test results from the microbiological tests carried out on seeds cannot be interpreted as proof that a batch is not contaminated with STEC O104:H4 since these results depend on and may be limited by both the analytical and diagnostic performance characteristics as well as by the nature of the sampling plan.

The number of member states that have received parts of the suspected lots is much larger than previously known and it cannot be excluded that other member states and third countries were supplied. The trace forward operation is becoming complex and widespread and may take weeks.

This report is one of many elements contributing to the investigation of the cause of this outbreak, and should not be considered in isolation. The findings of this report are consistent with other investigations conducted thus far. Specifically, it supports the hypothesis that the outbreaks in Germany and France are linked, and are due to the import of fenugreek seeds from Egypt, which became contaminated with STEC O104:H4 at some point prior to leaving the importer.

The contamination of seeds with the STEC O104:H4 strain reflects a production or distribution process, which allowed contamination with fecal material of human and/or animal origin. Where exactly this took place is still an open question. Typically such contamination could occur during production at the farm level.

Full report can be accessed at http://www.efsa.europa.eu/en/supporting/doc/176e.pdf
(European Food Safety Authority 7/5/2011)

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Asia
Australia: Fears for 23 people after Hendra virus goes undetected for two weeks
Biosecurity authorities fear that the deadly Hendra virus may have been spreading from a south east Queensland property for two weeks before it was finally detected on the weekend of 2-3 July 2011.

Biosecurity Queensland has quarantined the property at Mount Alford, 50 km south west of Brisbane, marking the third confirmed outbreak of the bat-borne disease in Queensland and northern New South Wales (NSW) in less than a week. A total of 23 people will wait weeks before knowing if they are infected with the virus, which has a 57% mortality rate among humans.

Among those most at risk is a veterinarian, who on 3 July 2011 confirmed that he had initially misdiagnosed the disease when he was called out to the property at Mount Alford to euthanize a horse on 20 June 2011. It was not until he was called back to the property on Friday, 1 July 2011 that he suspected a Hendra outbreak, a reality confirmed by government analysts that night. He was not wearing protective equipment when handling the first horse.

It was a shock to the system, because I could have taken a virus that's got a very high death rate in humans, he said. I could have been exposed to the virus for 13 days now, which is smack bang in the middle of the incubation period. The veterinarian, a former Queensland MP, on 3 July 2011 received the results of a preliminary blood test, which cleared him of Hendra, although he is due for another test on 22 July 2011, which he said is the one that really matters.

The virus, which has been detected only 17 times since 1994, has killed four of the seven humans who have contracted it, half of whom were vets. Over the weekend of 2-3 July 2011, Biosecurity Queensland officers began retracing the movements of all horses in and out of the Mount Alford estate, fearing the deceased horses may have come into contact with other horses at nearby properties.

A spokesman on 3 July 2011 could not confirm whether that process was complete. Authorities have locked down horses at three other properties in Queensland and NSW, including at Kerry, 45 km south of Brisbane, where a horse was euthanized and eight people have been tested for the virus. A further 20 horses have been tested at Biddaddaba, where the Kerry horse was brought before it died. Another horse was euthanized at Wollongbar, near Ballina, on the NSW north coast, and nine people there are being monitored for symptoms.

The virus, which is transmitted to horses by flying foxes, is known to emerge only in autumn and winter in Queensland and northern NSW, when the migrating creatures converge on flowering trees. The virus can be transmitted from bats to horses and, in rare cases, from horses to humans. There is no evidence that it can be transferred between humans.

The veterinarian defended his decision on 3 July 2011 not to wear protective equipment when tending to the horses, describing it as an inconvenience given outbreaks of Hendra remain relatively rare. It's like when you go and see your GP. You've got the flu, but he's not going to greet you in all of his gear, he said.

Horse owners have been advised to keep their animals, feeding troughs, and water containers away from fruit trees to minimize the risk of flying fox bites.

The CSIRO'S (Commonwealth Scientific and Industrial Research Organisation) Australian Animal Health Laboratory is developing a vaccine for the virus, but its developers are unsure whether or not it will be available before the next Hendra season.

In 2010, an outbreak on the Sunshine Coast prompted health authorities to administer an experimental anti-serum to a 12-year-old and her mother. The pair survived.
(The Australian 7/4/2011)

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Australia: First case of gnathostomiasis reported in the country
A Victorian couple endured a health nightmare after tiny worms with teeth began eating through their bodies. It is the first time humans have been infected by the parasite in Australia.

It is believed the couple became ill after eating a fish they caught on a Western Australia camping holiday. Alfred hospital infectious disease physician Andrew Fuller said that when the couple ate the fish, believed to be a black bream, they also ingested the gnathostomiasis larvae. The worms are one to three mm long and have got these sharp little teeth and they can go anywhere they like in the body, Dr. Fuller said.

The worm works its way around the human body until it dies or is killed by the immune system. They move under the skin and cause itchy lumps that can make you feel sick -- and it can be very hard to diagnose. The infected couple suffered muscle pain, fevers, vomiting, and their skin began to look like orange peel. They were given antibiotics and have recovered.

The worms can stay in a human for 15 years, leaving people chronically ill. They can make their way into the brain, other organs, and the spinal cord. They eat your tissues, Dr. Fuller said. He had treated 28 people with the condition, who all contracted it overseas. Neither of the latest patients had been overseas.

Dr. Fuller sent samples of their blood to Bangkok. The fish was caught in the Calder River, north of Derby, and the incident was reported in the Australian Medical Journal.
(ProMED 7/6/2011)

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Hong Kong: Mutated scarlet fever fuels outbreak
Ultramodern Hong Kong is tussling with a centuries-old bug long forgotten in many developed countries -- an outbreak of drug-resistant scarlet fever that has killed the first children there in a decade. And with it is the rise of a mutated strain that appears to be more contagious.

The number of cases has spiked in 2011 to more than 500, with health officials issuing warnings in the southern Chinese city jammed with seven million people and hypersensitive to any type of disease outbreak. Experts warn the main strain of the bacterial infection is likely transmitted easier. It is 60% resistant to two drugs of choice, up from a resistance level of 10 to 30% previously.

The illness leaves children with a fever, sore throat, bright red tongue and sandpapery rash. Penicillin still cures it, but doctors worry options will be limited if the germ eventually outsmarts that antibiotic before a vaccine is developed.

That's the cause of lots of nightmares, said Dr. Edward Kaplan. He heads a World Health Organization research center at the University of Minnesota that focuses on the strep germ, which causes scarlet fever. The fact that we still have penicillin is something we all get down on our knees and say prayers about each night.

The widespread availability of penicillin and the development of other new antibiotics in the 20th century virtually wiped out diseases that were once major killers in developed countries, such as tuberculosis. But the overuse and misuse of drugs -- patients not finishing a full prescription or taking antibiotics for a virus when they are only effective against bacteria -- have allowed old bugs to fight back and eventually overpower antibiotics, rendering some of them useless.

Penicillin, once useful to treat a number of ailments from gonorrhea to pneumonia, has lost much of its potency due to resistance that has built over decades. Some say it's a miracle it still works for the streptococci group that causes an array of diseases from strep throat to toxic shock syndrome and flesh-eating disease.

That's the one thing that we're both a bit fearful of and also, in one respect, really surprised that the bug hasn't developed penicillin resistance yet, said Mark Walker, a microbiologist and strep expert who heads the Australian Infectious Disease Research Center. We're very lucky. We still have a treatment we can use and additionally there are vaccines that are under development.

But even penicillin has its problems because many people are allergic to it. That means trying older antibiotics or newer drugs of last resort, which doctors typically try to avoid for fear of rendering those drugs useless, too. A vaccine against the germ that causes scarlet fever is likely years away.

Pockets of drug-resistant scarlet fever, which typically spreads through coughing and sneezing and is most common in children under ten, have sprung up over the past few decades in various parts of the world. And while the Hong Kong deaths and rise in cases are disturbing, the resistance seen in the standard treatments erythromycin and clindamycin is not new, Kaplan said.

A 7-year-old girl who died in May became the first recorded scarlet fever death in Hong Kong in at least ten years, while a 5-year-old boy also died on 21 June 2011. Both deteriorated quickly in the hospital and were killed by toxic shock syndrome resulting from the infection. The children were infected with two different common strains of scarlet fever that are circulating simultaneously, both antibiotic resistant. However, the one that appears to be dominant also has undergone a genetic mutation that may make it easier to spread, said Kwok-yung Yuen, head of Hong Kong University's microbiology department, who sequenced samples taken from the current outbreak.

The nearly 550 cases of scarlet fever so far in 2011 are about double Hong Kong's annual total. Local media also are reporting some 9,000 cases detected in mainland China, also about twice the normal rate there, but it's unclear if it's becoming a regional problem because many countries do not track the common childhood illness, according to the World Health Organization.

Scarlet fever, also called scarlatina, was once a highly feared scourge in Europe and the United States. Clothes, bedding and toys were often burned and children were sometimes isolated after infection, as portrayed in the popular 1920s children's book, "The Velveteen Rabbit." Experts say they fear rising drug resistance could one day take the world back to a time when there were no easy treatments.

This will really turn us back to 1940s in terms of treatment of infectious disease if this trend continues, Yuen said.
(CTV News 6/27/2011)

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New Zealand: Measles cases escalate in Auckland
The news of a freshly imported case of measles brings the total number of confirmed cases in Auckland's largest outbreak in 2011 to 39. Auckland Regional Public Health Service (ARPHS) medical officer of health, Dr. Richard Hoskins, says that since nine of the cases are not able to be linked to cases from Oratia, plus another case from overseas, the focus now must be on immunization.

Given the level of community spread, this is the only option remaining to try to limit the spread of measles, says Dr. Hoskins. Immunization is the only way to avoid getting measles. The vaccination is funded for children, young people and unimmunized adults. These new cases have been in several early childhood centres, and we are now working with those centres to quarantine susceptible contacts at home in case they develop measles, says Dr. Hoskins. We strongly advise all children receive two doses of the MMR (measles, mumps, rubella) vaccine at 15 months and four years. We also strongly advise catch up vaccinations for adolescents and adults who have had either none, or only one dose of MMR vaccine, particularly if they are intending to travel overseas.

Dr. Hoskins says passengers on a recent flight from Bangkok to Auckland might have been exposed to the measles virus. Thai Airways flight TG491 landed in Auckland on Sunday 19 June 2011, carrying a passenger who was in the early stages of measles and capable of infecting others. All passengers onboard the flight who have not had the right number of measles immunizations for their age, or are unsure, should be vigilant if they suspect they could have measles, says Dr. Hoskins. We will be trying to contact a number of passengers who were sitting close to the passenger with measles.
(ProMED 7/4/2011)

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New Zealand: Measles outbreak continues in Hawke’s Bay
As the measles outbreak continues in Hawke's Bay, schools and early childhood centres that have a measles case reported will be asked by public health staff to exclude any child not immunized or who can't produce an up-to-date immunization certificate to help prevent the virus spreading.

Hawke's Bay District Health Board medical officer of health Lester Calder said a recent measles case at Henry Hill School, Napier highlighted the importance of ensuring immunization certificates were up-to-date and copied to schools or childhood centre management, as 48% of the school roll had to be excluded until immunization records could be produced. This number has now dropped to 7% of children being excluded.

Dr. Calder said this was the third school which had to exclude pupils while they awaited immunization certificates. Excluding children caused family disruption often impacting on parents' ability to work, and it could so easily be prevented by ensuring children's immunizations were up-to-date and their immunization record was copied to the school or childcare centre.

The district health board is waiting for final genotyping to come back to prove all cases were linked to an initial case in Auckland; however, genotype information received so far suggested all the cases were linked.

The high level of immunity in Hawke's Bay had prevented a much greater epidemic, but there had been clusters in Flaxmere, Hastings, Napier and Maraekakaho, highlighting how contagious this virus was, Dr. Calder said. If a measles case was reported at a school or childcare centre, children not immunized or who didn't have an immunization certificate as part of their school record would be excluded from school for two weeks until an immunization certificate was produced. If there was a further case, children not immunized or without an immunization certificate would be excluded for a further two weeks.

Since April 2011, 25 cases of the highly contagious virus have been reported in Hawke's Bay, and of those, four including one adult have been hospitalized.
(ProMED 7/4/2011)

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Philippines: Measles cases in Capiz on the rise
Records from the Provincial Health Office of Capiz showed that out of 49 suspected measles cases in Capiz from January to 17 June 2011, 18 individuals were found positive for the disease based on laboratory results from the Department of Health, according to Capiz DOH representative Dr. Elmer Bucayan. He explained that blood samples were taken in 46 cases. These were sent to DOH in Manila for analysis.

The three other cases are considered epidemiologically linked cases, hence, no blood samples were taken. Bucayan said that they are still waiting for the results of the 28 patients suspected of having measles and whose blood samples were earlier submitted to their higher office for laboratory examination. Of the total confirmed cases, ten are from Roxas City, two from Dao, and one case each from Dumalag, Jamindan, Mambusao, Panay, Pilar, and Sigma. The oldest to have been confirmed with measles is a 52 year old person with no history of immunization.

Recently, the government has stepped up its anti-measles immunization campaign throughout the entire nation using a door-to-door strategy to reach all the eligible children in the population and to eradicate measles in the Philippines by 2012.
(ProMED 6/26/2011)

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Russia (Udmurtia): Hemorrhagic fever with renal syndrome
The regional administration of Rospotrebnadzor (Federal Service for Consumer Protection and Human Welfare) has released a statement concerning hemorrhagic fever with renal syndrome (HFRS) in the Udmurtia region. Sampling surveys of forest rodents show a two to four fold increase in population size compared with 2010 and high infection rates (9-13%).

However, HFRS incidence during the first five months of 2011 was lower than for the comparable period of 2010 (70 cases in 2011), but since the beginning of June 2011 the incidence has begun to increase. Also the proportion of severe cases in 2011 is greater than during 2010. There has also been one fatality -- a young man living in the town of Izhevsk.

The main route of HFRS infection is respiratory (via dust generated during cleaning activities), alimentary (consumption of contaminated food), and by transmission via soiled hands while smoking or eating. A considerable number of cases have been a consequence of gardening and participation in other outdoor activities. Indeed, 43.8% of cases of cases in the city of Izhevsk have been contracted in this manner. Up to one third of cases of HFRS are contracted during the period when people spend time out-of-doors collecting mushrooms or picking berries in the surrounding forests. It is predicted that the situation will continue to deteriorate into the autumn due to the increase in the rodent population.
(ProMED 6/30/2011)

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Russia: Swine fever may hit
African swine fever (ASF), lethal to pigs though harmless to humans, has reached central Russia and may spread to all European parts of the country, the country's chief veterinarian said on 28 June 2011.

We are on the verge of a new wave of proliferation of the virus, Nikolai Vlasov, who is also deputy head of the animal and plant health watchdog Rosselkhoznadzor, said. He said that outbreaks of ASF, which has no cure, have been registered in 2011 at five small farms in the central Russian region of Tver, bordering the Moscow region.

Medium and large Russian pig breeding farms are well protected against ASF and other diseases. It is mainly small farms that are affected by the contagious virus, which is spread partly by wild boars.

ASF, which was confirmed for the first time in Russia in 2007, has so far been found mainly in the south of the country. It continues spreading due to delays in the adoption of efficient measures to prevent its proliferation.

Three years ago, the disease was discovered outside the Southern Federal District only twice. In the first six months of 2011, the virus was found in five regions outside the district, in northwestern and central Russia, Vlasov said. We give instructions, which are ignored, he said.

The watchdog earlier in 2011 proposed a program to eradicate the pig killer within seven years, costing around USD 400 million. The government has so far failed to approve it.

If things continue to go as they do now in the Tver region, where wild boars are plentiful, the northwest of the country may soon start resembling the south, Vlasov said. Wide proliferation of any infectious disease in Russia is a global problem due to its colossal territory and the huge number of countries it has borders with, he added.
(ProMED 6/30/2011)

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Viet Nam: More than 45,000 animals die of foot-and-mouth disease
A foot-and-mouth (FMD) epidemic has broken out in 39 provinces, affecting more than 150,000 head of cattle. More than 45,000 animals have died or been destroyed, including over 5,000 buffalos, 938 cows, 37,760 pigs, and 329 goats. These figures were from the report delivered by the Animal Health Department at a meeting in Hanoi on 24 June 2011 to sum up the prevention of the disease.

At the meeting, Hoang Van Nam, head of the department under the Ministry of Agriculture and Rural Development, stressed that the epidemic had spread more quickly than previous years because of the carelessness of local inhabitants and authorities. Nam said they did not closely manage the epidemic hot spots and did not destroy diseased cattle as instructed. Bad weather and the habit of tending buffalos and cows on a small scale contributed to the high risk of epidemics, Nam added.

The Animal Health Department has asked provinces to work out programmes to prevent the disease, organize vaccinations for 2011, and use the correct vaccines. The aim is to contain FMD in 2015.

Addressing the meeting, deputy minister of agriculture and rural development Diep Kinh Tan warned that FMD virus strains are constantly evolving. He said Viet Nam has found effective vaccines to fight the disease, but veterinary agencies must continue to closely monitor the epidemic.
(ProMED 6/26/2011)

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Americas
Canada: Bovine tuberculosis on Cherryville farm
Bovine tuberculosis (TB) has been confirmed on a farm in the Cherryville area east of Vernon.

Kevin Boon of the B.C. Cattleman's Association says the infection was discovered back in May 2011. Testing for bovine TB is part of a normal investigation and can easily be detected and picked up on thorough investigation.

Tuberculosis is a contagious disease caused by an infection in the lymph nodes, which is then spread to other organs like the lungs. The disease is spread through the air by coughing as well as through contaminated feed and water. Young calves may be infected by drinking unpasteurized infected milk.

Once the disease has been detected, it must be processed by the Canadian Food Inspection Agency. The CFIA tests all animals, and all infected animals and all exposed susceptible animals may be destroyed. This is the only proven way to eliminate the disease. Boon says producers can suffer financially if their cattle contract bovine TB, as they must pay to have all their cattle tested and quarantined. If they are waiting for CFIA to conduct tests, they may miss the opportunity to market their cattle.

Owners could be compensated under the Health of Animal Act if the cattle have to be destroyed. Boon says sometimes the government is able to help with financial compensation.

Once a CFIA inspector has confirmed that the premises have been cleaned and disinfected, the quarantine can be lifted. The owner must wait 30 days before they can replace their cattle. All replacement animals have to be tested for up to four years.

The last outbreak of bovine TB in 2007 led to the slaughter of almost 500 cattle in B.C. and Alberta.

According to Boon, the current outbreak of bovine TB does have the potential for trade consequences. However, Communications Specialist for CFIA Christine Russell says as of 24 June 2011, this infection has not affected Canada's TB-free status. Because Canada's TB status remains unchanged, this does not affect trade with our American partners.

Humans can contract bovine TB. Owners and handlers of infected cattle are at risk for the disease, although Boon says the disease is not easily transmitted to humans.
(ProMED 6/26/2011)

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Chile: New cases of respiratory syncytial virus infection in children
A week after the respiratory syncytial virus (RSV) prompted an alert by the health minister, Jaime Manalich, it has been reported that there is still a substantial increase in cases in the need of hospitalization. This is because 90% of children who are referred to health services with respiratory problems require hospital admission: in eight out of ten such cases the infection can lead to pneumonia.

800 new cases of RSV infection in children are being recorded every week, according to the secretary of state. For his part, under-secretary for health care Luis Castillo said that so far 231 new beds had been provided in addition to the 535 beds already converted as part of the Winter Plan, to provide in total 766 additional pediatric beds in the system. A total of eight hospitals (Roberto del Río, Exequiel Gonzalez Cortes, Sotero del Rio, Calvo Mackenna, Padre Hurtado, Gustavo Fricke, Van Buren and Felix Bulnes) are providing ventilators and monitors to convert beds to acute care facilities.

The under-secretary stated that during 24 June to 26 June 2011 the directors of health services in the metropolitan region and the areas with the highest incidence of RSV infection will take steps to verity that the network is fully functional. We have organized a series of hospital visits for 24 June to 26 June 2011. In addition information will be circulated online to monitor the situation in the emergency care network in order to respond immediately to demands, said Castillo.

Also from 24 June 2011 until 31 July 2011, the army will also be supporting the public health system in dealing with RSV.
(ProMED 6/25/2011)

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USA: High number of reported measles cases in 2011 -- linked to outbreaks abroad
The United States is experiencing a high number of reported measles cases in 2011, many of which were acquired during international travel. From 1 January 2011 to 17 Jun 2011, 156 confirmed cases of measles were reported to CDC (Centers for Disease Prevention and Control).

This is the highest reported number since 1996. Most cases (136) were associated with importations from measles-endemic countries or countries where large outbreaks are occurring. The imported cases involved unvaccinated US residents who recently had traveled abroad, unvaccinated visitors to the United States, and people linked to these imported cases. As of 22 June 2011, 12 outbreaks (three or more linked cases) have occurred, accounting for 47% of the 156 cases. Of the total case-patients, 133 (85%) were unvaccinated or had undocumented vaccination status. Of the 139 case-patients who were US residents, 86 (62% were unvaccinated, 30 (22%) had undocumented vaccination status, 11 (8%) had received one dose of measles-mumps-rubella (MMR) vaccine, 11 (8%) had received two doses, and 1 (1%) had received three doses.

Measles had been declared eliminated in the United States in 2000 due to our high two-dose measles vaccine coverage, but it is still endemic or large outbreaks are occurring in countries in Europe (including France, the United Kingdom, Spain, and Switzerland), Africa, and Asia (including India). The increase in measles cases and outbreaks in the US in 2011 underscores the ongoing risk of importations, the need for high measles vaccine coverage, and the importance of prompt and appropriate public health response to measles cases and outbreaks.
(ProMED 6/26/2011)

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USA: Multistate outbreak of human Salmonella enterica infections linked to alfalfa sprouts and spicy sprouts
CDC is collaborating with public health officials in many states and the FDA to investigate a multistate outbreak of Salmonella enterica. Enteritidis infections linked to alfalfa sprouts and spicy sprouts. There is no connection between this outbreak and the European E. coli O104:H4 outbreak. Investigators are using DNA analysis of Salmonella bacteria obtained through diagnostic testing to identify cases of illness that may be part of this outbreak.

As of 27 June 2011, a total of 21 persons with the outbreak strain of S. enterica have been reported from 5 states: Idaho (3), Montana (7), North Dakota (1), New Jersey (1), and Washington (9). Among persons for whom information is available, illnesses began between 12 April 2011 and 7 June 2011. Ill persons range in age from 12 years to 77 years old, with a median age of 35 years. 71% are female. Among the ten ill persons with available information, three (30%) persons have been hospitalized. No deaths have been reported.

Collaborative investigative efforts of local, state, and federal public health and regulatory agencies have linked this outbreak to Evergreen Produce brand alfalfa sprouts and spicy sprouts. The sprouts were distributed to various customers in Idaho, Montana, Washington State, and possibly to retailers in neighboring states. CDC, FDA, and state and local public health partners are continuing surveillance to identify new cases and trace potentially contaminated products. CDC will continue to update the public on the progress of this investigation as information becomes available.
(CDC 6/28/2011)

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USA (Alabama): E. coli outbreak at water park
The Alabama Department of Public Health (ADPH) continues its investigation of an E. coli O157:H7 outbreak in Lee County. 13 children and two adults who either played in the Splash Park or swam in the pool at the Opelika SportsPlex and Aquatic Center between 4 and 22 June 2011 were identified with severe gastrointestinal illness.

As of 28 June 2011, five children have been confirmed positive for E. coli O157:H7 infection. Four children were initially hospitalized and two remain hospitalized. The Health Department has contacted the parents of children of seven day care centers that had children at the Splash Park during the period of concern. Symptoms of E. coli can appear up until ten days after exposure.

Based on the information that we have now, it appears that the common source of exposure was the Aquatic Center, said State health officer Dr. Donald Williamson. Because of the risk for outbreak of illness, it is essential that public pools and water parks follow Centers for Disease Control and Prevention guidelines for adequate chlorine and pH levels.

Illnesses in recreational waters are caused by germs spread by swallowing, breathing in mists or aerosols, or having contact with contaminated water in swimming pools, water parks, hot tubs, interactive fountains, water play areas, lakes, rivers, or oceans. Infection may also occur by touching the environment in petting zoos and other animal exhibits or by eating food prepared by people who did not wash their hands well after using the toilet.

ADPH notified city officials of possible contamination on 20 June 2011. ADPH collected water samples for testing from the facilities at the Aquatic Center. The ADPH Bureau of Clinical Laboratories ran the initial tests, which were negative for bacteria. Negative results do not guarantee that bacteria were not present. Additional water samples have been collected and sent to the CDC for testing and results are pending.

People with diarrhea caused by potential waterborne pathogens should not use recreational water venues such as swimming pools, water slides, and water parks for 2 weeks after symptoms resolve. Following CDC guidelines, the City of Opelika has treated all facilities at the Splash Park and Aquatic Center, and the facilities are open.
(Alabama Department of Public Health 6/28/2011)

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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
Indonesia (Jakarta city, Jakarta Raya).
Based on local health sub-department data, since January to June 2011, there are only 691 dengue fever cases noted. This number is a decrease compared with the same period in 2010, which reached 2,563 cases or a decrease to 1,872 cases. .
(ProMED 6/26/2011)


Mexico (Pinotepa de Don Luis, Oaxaca state)
Alvaro Sanchez Sanchez, the physician in charge of the Rural Medical Unit 172 of the IMSS (Instituto Mexicano de Seguridad Social; Mexican Social Security Institute) of this community in an interview said that up to now, 146 probable dengue cases have been registered, 21 of which have been confirmed as classical dengue fever and seven as DHF. Of these 146 probable registered cases, 79 were male and 70 female, with an age range of 10-44 years.
(ProMED 6/26/2011)


Mexico (Jalisco state)
In 2011, 66 dengue infections have been registered in the whole state, and as of 28 June 2010, there were 600 people affected, said the Head of the Department of Vectors and Zoonoses of the Jalisco state Secretariat of Health, Leandro Hernandez Barrios.
(ProMED 7/5/2011)


Mexico (Veracruz state)
According to the state secretary of health, Pablo Anaya Rivera, just 64 classical dengue fever cases have been tallied, most in the northern area of the state. As of 24 June 2011, this total is a decline of 50% of dengue cases compared with 2010.
(ProMED 6/26/2011)


Singapore
A rarely-seen type of dengue virus -- DEN-3 -- has hit the Marsiling area with more than 60 cases reported as of Friday, 24 June 2011. The Marsiling area has seen two clusters of dengue virus transmission recently, with the first detected at Marsiling Rise on 21 April 2011. The second cluster detected on 19 May 2011 is also the largest so far in 2011.
(ProMED 7/5/2011)


Viet Nam (Mekong Delta region)
There seems to be a widespread outbreak of dengue fever in the Mekong Delta region with six reported deaths in Ca Mau, Soc Trang, and Vinh Long provinces. Can Tho City has nearly 300 patients concentrated mainly in Vinh Thanh, Phong Dien, Co Do, and Thoi Lai districts with 30-35% in serious condition. There is a 10% increase of cases since the same period in 2010. Ca Mau Province has two reported deaths and more than 1,400 patients, mainly in Dam Doi, Thoi Binh, Tran Van Thoi, and Cai Nuoc districts as well as in Ca Mau City. Figures coming in from other provinces are: about 700 patients and two reported deaths in Soc Trang; more than 290 patients with two reported deaths in Vinh Long; 510 patients in Dong Thap; 124 patients in Hau Giang; nearly 300 patients in Tien Giang; about 200 patients in Tra Vinh.
(ProMED 6/26/2011)


Russia
According to the regional Rospotrebnadzor (Federal service for consumer protection and human welfare), 16,439 people have reported tick bites as of 17 June 2011, which is a considerable increase over the figure of 11,547 tick bites reported during the same period of 2010. A total of 3,861 (23.4%) of the cases of tick bite involved children under the age of 14 years.

In all, 379 people have been hospitalized with suspected tick-borne encephalitis (TBE), a figure that includes 35 children under 14 years of age. In 49 cases, the diagnosis of TBE has been confirmed by laboratory analysis.

In addition, there were 63 confirmed diagnoses of tick-borne borreliosis (Lyme disease).

During the first six months of 2011, there have been three fatalities as a consequence of TBE. None of them had been immunized against TBE virus infection. One of the TBE cases received emergency prophylaxis with TBE virus immunoglobulin, but the patient did not survive. All three fatal cases were residents of Novosibirsk city. Only one of them actually recalled having been bitten by a tick.
(ProMED 7/1/2011)


USA (Minnesota)
A woman in her 60s from northern Minnesota has died from a brain infection (presumed to be encephalitis) due to Powassan (POW) virus infection. This is the first death in the state attributed to the disease.

One other likely POW virus infection case has been identified in 2011 in Minnesota, in an Anoka County man in his 60s who was hospitalized with a brain infection and is now recovering at home. POW virus is transmitted through the bite of an infected tick.

Both 2011 cases became ill in May after spending time outdoors and noticing tick bites. The fatal case was likely exposed to ticks near her home. The case from Anoka County might have been exposed near his home or at a cabin in northern Minnesota. Health officials say this death serves as a reminder of the vital importance of preventing tick bites.

Although Powassan cases are rarely identified, it is a severe disease which is fatal in about 10% of cases nationwide, and survivors may have long-term neurological problems, said Dr. Ruth Lynfield, state epidemiologist with the Minnesota Department of Health (MDH). Powassan disease is caused by a virus and is not treatable with antibiotics, so preventing tick bites is crucial.

In Minnesota, POW virus can be transmitted by the blacklegged tick (also called the deer tick), which can also carry Lyme disease, anaplasmosis, and babesiosis. The blacklegged tick is abundant during our warm weather months in hardwood and mixed-hardwood forests of Minnesota. When a tick infected with POW virus attaches to a person, it might take only minutes of tick attachment for the virus to be transmitted.

POW virus infection was first detected in Minnesota in 2008, in a Cass County child who was exposed near home. In 2009-2010, five additional POW cases were identified in Minnesota. These cases were likely exposed to infected ticks in north-central or east-central counties (Cass, Carlton, Hubbard, Itasca, or Kanabec). In addition to these human cases, MDH has found POW-infected ticks in northern counties (Cass, Clearwater, and Pine) and in southeastern Minnesota (Houston County).

POW virus was first described in 1958 in Powassan, Ontario. Since then, about 60 cases have been identified in North America. Most of these cases were from eastern Canada and the northeastern USA until the last decade, when cases began to be reported from Michigan, Wisconsin, and now Minnesota.

To prevent tick-borne diseases, always use tick repellents containing DEET (up to 30% concentration) or permethrin when spending time in tick habitat. Products with DEET can be used on the skin or clothing. Permethrin-based products, which are only applied to clothing, are highly effective and can last through several washings and wearings. Also, wear long pants and light-colored clothing to help detect and remove ticks before they've had time to bite. People with homes or cabins near the woods can also use landscape management and targeted pesticide applications to reduce exposure to disease-carrying ticks.

After returning from outdoors, check your body carefully for ticks and promptly remove any you find. The process of bathing or showering shortly after returning indoors can help remove ticks before they bite or before they've been attached for long.
(ProMED 7/4/2011)

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4. Articles
Rural–Urban Differences in the Location of Influenza Vaccine Administration
Bennetta KJ, Pumkama C, Probst JC. Vaccine. 25 June 2011; doi:10.1016/j.vaccine.2011.06.038.
http://www.sciencedirect.com/science/article/pii/S0264410X11009029

Background. Influenza vaccination rates remain lower than Healthy People 2010 goals. The lower rates are prevalent in rural areas despite an expansion of services to nontraditional settings. Little is known about disparities in influenza vaccination rates and location of receipt among rural residents. This study seeks to determine if rural residents differ from urban residents in where they obtain an influenza vaccination, and to determine what factors contribute to these differences.

Methods. Data from 2002–2005 BRFSS were used and combined with the 2006 Area Resource File (analytic n = 70,468, unweighted, 48,392,455 weighted). Unadjusted analyses examined the proportions of influenza vaccinations obtained in traditional clinical settings vs. others across rurality: Urban, Large Rural and Small Rural. Multivariable logistic regression models were conducted to identify individual and county-level factors associated with the higher rate of vaccinations in clinical settings.

Results. Rural residents, particularly in Small Rural counties (80.8%) were more dependent upon clinical settings than urban residents (69.1%) for influenza vaccinations. In adjusted analyzes, living in a Large or Small Rural county remained significant related to an increased odds of being vaccinated in a clinical setting (OR 1.17, 95% CI 1.06–1.29 and OR 1.45, 95% CI 1.24–1.69 respectively). Other related contributory factors included socioeconomic factors, health status, health condition, and per capita income of the county.

Conclusions. Rural residents depend upon traditional, clinical settings when an influenza vaccination is sought. The results can be used for further research and programs to improve access to and delivery of influenza vaccinations for disparate populations.

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The Geographic Synchrony of Seasonal Influenza: A Waves across Canada and the United States
Schanzer DL, Langley JM, Dummer T, et al. PLoS ONE. 28 June 2011; 6(6): e21471. doi:10.1371/journal.pone.0021471.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0021471?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+%28PLoS+ONE+Alerts%3A+New+Articles%29

Background. As observed during the 2009 pandemic, a novel influenza virus can spread globally before the epidemic peaks locally. As consistencies in the relative timing and direction of spread could form the basis for an early alert system, the objectives of this study were to use the case-based reporting system for laboratory confirmed influenza from the Canadian FluWatch surveillance program to identify the geographic scale at which spatial synchrony exists and then to describe the geographic patterns of influenza A virus across Canada and in relationship to activity in the United States (US).

Methodology/Principal Findings. Weekly laboratory confirmations for influenza A were obtained from the Canadian FluWatch and the US FluView surveillance programs from 1997/98 to 2006/07. For the six seasons where at least 80% of the specimens were antigenically similar, we identified the epidemic midpoint of the local/regional/provincial epidemics and analyzed trends in the direction of spread. In three out of the six seasons, the epidemic appeared first in Canada. Regional epidemics were more closely synchronized across the US (3–5 weeks) compared to Canada (5–13 weeks), with a slight gradient in timing from the southwest regions in the US to northeast regions of Canada and the US. Cities, as well as rural areas within provinces, usually peaked within a couple of weeks of each other. The anticipated delay in peak activity between large cities and rural areas was not observed. In some mixed influenza A seasons, lack of synchronization sub-provincially was evident.

Conclusions/Significance. As mixing between regions appears to be too weak to force a consistency in the direction and timing of spread, local laboratory-based surveillance is needed to accurately assess the level of influenza activity in the community. In comparison, mixing between urban communities and adjacent rural areas, and between some communities, may be sufficient to force synchronization.

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Escherichia coli O104:H4 from 2011 European Outbreak and Strain from Republic of Korea
Kim J, Oh K, Jeon S, et al. Emerg Infect Dis. September 2011; [Epub ahead of print]. doi: 10.3201/eid1709.110879.
Available at http://www.cdc.gov/eid/content/17/9/pdfs/11-0879.pdf

To the Editor. Beginning in early May 2011, an outbreak caused by Shiga toxin– producing Escherichia coli O104:H4 was reported in Germany and other countries in Europe. In this outbreak, the number of hemolytic uremic syndrome (HUS) cases has been unusually high. As of 9 June 2011, a total of 722 cases of HUS, 19 deaths, and 2,745 cases of enterohemorrhagic E. coli (EHEC) infection were reported. A case of HUS caused by E. coli O104:H4 was first reported in South Korea in 2004. Because infections caused by E. coli O104:H4 have been reported rarely, interest has arisen in the E. coli O104:H4 strain from South Korea. We characterized the E. coli O104:H4 strain isolated in South Korea (EC0417119) in 2004 and compared it with the E. coli O104:H4 strain associated with the current EHEC outbreak in Europe.

Infections with the EHEC O104 strain were reported several times worldwide. In Europe, such occurrence was rare, and before the current outbreak, the EHEC O104:H4 strain was documented only once in South Korea. For this reason, it was logical to examine the possible relatedness of the EC0417119 strain and the strain causing the current outbreak. However, the EC0417119 strain has many different characteristics compared with the current outbreak strain; not possessing enteroaggregative E. coli determinant, not producing extended spectrum â- lactamases, and not showing indistinguishable PFGE patterns. In conclusion, there is no evidence that the E. coli O104:H4 strain isolated in South Korea in 2004 is related to the strain that has a caused the massive and unprecedented EHEC outbreak in Europe.

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Development and Validation of an Instrument to Assess the Risk of Developing Viral Infections in Australian Travelers During International Travel
Ratnam I, Torresi J, Matchett E, et al. J Travel Med. July 2011; 18(4):262-270. doi: 10.1111/j.1708-8305.2011.00533.x. Epub 2011 Jun 15.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21722238

Background. Questionnaires are widely used for data collection in travel medicine studies, but there are no validated instruments that are available to researchers in this field. Our objective was to develop and validate a questionnaire to be used in a prospective study designed to estimate the risk of three viral infections in Australian travelers to Asia.

Methods. Qualitative nonexperimental cognitive methods, including cognitive review, task analysis, and cognitive interviews, were selected. A pilot study was performed to assess the instrument in the target population.

Results. Recalling dates related to travel or health events was observed and reported to be the most difficult task for travelers. The use of cues embedded into items and provision of memory prompts such as calendars improves the recall of dates during travel. There is a wide spectrum of accommodation, activities, and travel experiences, and item responses that were constructed as lists were useful as memory triggers, particularly for travelers with long and complicated itineraries. Cognitive interviews provided a valuable insight into how travelers used inferential and direct memory to recall travel events and their confidence in the accuracy of these processes.

Conclusions. The development and validation of questionnaires improve the accuracy of the data collected and should be considered an integral part of the methodology of travel-related studies.

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Clostridium difficile Laboratory Testing in Australia and New Zealand: National Survey Results and Australasian Society for Infectious Diseases Recommendations for Best Practice
Ferguson JK, Cheng AC, Gilbert GL, et al. Pathology. 29 June2011. [Epub ahead of print]
Available at http://www.ncbi.nlm.nih.gov/pubmed/21716158

Aims. In order to improve the future reliability of surveillance for Clostridium difficile infection (CDI), an Australia/New Zealand-wide survey was conducted to examine methods of laboratory diagnosis in use, identify deficiencies in practice and burden of CDI.

Methods. An online survey of 48 Australian and New Zealand microbiology laboratories (private and public) was conducted in late 2009 and 2010 to collect information about methods of detection in use and collective testing experience from July 2008 to June 2009.

Results. The overall prevalence (proportion positive of all faecal specimens tested) of C. difficile in 123 574 tested samples was 5.3%. The incidence rate across jurisdictions varied between 18.0 per 100 000 population in Victoria to 35.8 per 100 000 population in Tasmania, with a mean for Australia of 25.6 per 100 000 population. The incidence rate in New Zealand was 21.5 per 100 000 population. Most laboratories (60%) screened stools with an enzyme immunoassay (EIA) or equivalent that detected both toxins A and B.

Conclusions. The low overall rates reported here may reflect the lack of sensitivity of diagnostic testing procedures currently used in Australia and New Zealand to detect C. difficile. Recommendations for best practice in diagnosis of C. difficile were developed by the Australasian Society for Infectious Diseases (ASID) C. difficile working party and later endorsed by ASID.

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Virological Surveillance of Human Influenza in Indonesia, October 2008-March 2010
Yamaoka M, Palilingan JF, Wibisono J. et al. Microbiol Immunol. July 2011; 55(7):514-517. doi: 10.1111/j.1348-0421.2011.00344.x.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21707740

Abstract. Despite the high prevalence of highly pathogenic H5N1 influenza A viruses in Indonesia, epidemiology information on seasonal human influenza is lacking. The present authors, therefore, conducted virologic surveillance in Surabaya, East Java from October 2008 to March 2010. Influenza viruses, including pandemic (H1N1) 2009 viruses, were isolated from 71 of 635 individuals tested. Seasonal influenza peaked in the rainy season. Compared with seasonal influenza viruses, pandemic 2009 viruses were isolated from younger patients with milder symptoms. Given the high prevalence of H5N1 infections in humans, continued influenza surveillance is essential for pandemic preparedness.

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Outbreak of Measles in the Republic of Korea, 2007: Importance of Nosocomial Transmission
Choi WS, Sniadack DH, Jee Y, et al. J Infect Dis. July 2011; 204 Suppl 1:S483-90.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21666204

Background. From 2002 through 2006, Republic of Korea conducted extensive measles elimination activities and declared elimination in 2006. An outbreak of measles involving 180 confirmed cases occurred during 2007.

Methods. An outbreak investigation was performed and enhanced surveillance was implemented. Detailed case investigations and laboratory testing included serologic and molecular diagnostic methods. Cases were classified according to World Health Organization and national guidelines.

Results. During 2007, 451 suspected cases were reported and 180 (40%) cases were confirmed as measles during epidemiologic weeks 14-42. Incidence during the outbreak was 3.7 cases per million persons, excluding imported cases. Most confirmed cases were reported from Seoul; 137 (76%) cases were among children <24 months old, 124 (69%) case patients had no history of measles vaccination, and 81 (45%) case patients resulted from nosocomial transmission in 6 hospitals. Community members, patients, and health care workers all contributed to measles virus transmission. Limited outbreak control measures were implemented; high population immunity likely accounted for the self-limited transmission during this outbreak.

Conclusions. Limited outbreaks of measles, in which nosocomial transmission can play an important role, may occur after countries have declared elimination. Timely and opportunistic vaccination may help prevent such outbreaks; high-quality surveillance is critical for their detection.

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Epidemiology of a Measles Epidemic in Vietnam 2008-2010
Sniadack DH, Mendoza-Aldana J, Huyen DT, et al. J Infect Dis. July 2011; 204 Suppl 1:S476-82.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21666203

Background. Vietnam conducted a measles catch-up supplementary immunization activity (SIA) during 2002-2003 that targeted children 9 months-10 years of age, followed by subnational SIAs targeting persons up to 20 years of age during 2004 and 2007-2008. A measles epidemic began among young adults in October 2008 in the northern region, spread nationwide during early 2009, and continued during 2010.

Methods. We reviewed national epidemiologic and laboratory surveillance data. Measles cases were defined and classified according to World Health Organization recommendations.

Results. From October 2008 through January 2010, 7948 confirmed measles cases were reported from 60 of 63 provinces, an incidence of 93 cases per million population. Incidence was 328 cases per million population among children age 1-4 years, 318 cases per million population among infants, and 271 cases per million population among persons aged 20-24 years. Few cases were reported among persons 7-17 or >27 years of age. Median age of cases trended downward over time in all regions.

Conclusions. The 2002-2003 measles SIA protected its targeted age group, but follow-up subnational SIAs in selected provinces did not prevent this epidemic during 2007-2008. Transmission began among young adults and was sustained among children. The outcome of Vietnam's 2010 SIA targeting children only and change in routine schedule may influence elimination strategies for other countries.

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Progress and Challenges for Measles Elimination by 2012 in the Western Pacific Region
Sniadack DH, Mendoza-Aldana J, Jee Y, et al. J Infect Dis. July 2011; 204 Suppl 1:S439-46.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21666197

Background. The 37 countries and areas of the World Health Organization (WHO) Western Pacific Region have targeted measles for elimination by 2012.

Methods. We reviewed routine and supplementary immunization coverage based on 2010 WHO/United Nation's Children's Fund (UNICEF) estimates and Joint Reporting Forms and epidemiologic and laboratory data submitted by the countries and areas.

Results. In 2009, 21 of 37 countries and areas had ¡Ý90% coverage with a first dose of measles vaccine; 32 countries and areas provided 2 routine doses of measles vaccine with 94% weighted average coverage among those reporting. From 1996 to 2009, 235 million persons received measles vaccine during 94 immunization campaigns in 30 countries and areas. As of 2009, 2.8 suspected cases per 100,000 population were discarded as nonmeasles; however, only 43% of second level administrative units reported at least 1 discarded case per 100,000. Adequate specimen collection rate was 71%. Measles incidence was 34 per million population in 2009, a 58% decrease compared with 2008 and the lowest ever reported. As many as 25 countries and areas already may have eliminated measles.

Conclusions. Achieving the 2012 measles elimination goal is feasible provided political and financial commitments are increased at every level to further improve routine and supplementary immunization activity (SIA) coverage and surveillance in every district.

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Deaths Associated With Bacterial Pathogens Transmitted Commonly Through Food: Foodborne Diseases Active Surveillance Network (FoodNet), 1996-2005
Barton Behravesh C, Jones TF, Vugia DJ et al. J Infect Dis. July 2011; 204(2):263-7.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21673037

Background. Foodborne diseases are typically mild and self-limiting but can cause severe illness and death. We describe the epidemiology of deaths associated with bacterial pathogens using data from the Foodborne Diseases Active Surveillance Network (FoodNet) in the United States.

Methods. We analyzed FoodNet data from 1996-2005 to determine the numbers and rates of deaths occurring within 7-days of laboratory-confirmation.

Results. During 1996-2005, FoodNet ascertained 121,536 cases of laboratory-confirmed bacterial infections, including 552 (.5%) deaths, of which 215 (39%) and 168 (30%) were among persons infected with Salmonella and Listeria, respectively. The highest age-specific average annual population mortality rates were in older adults (¡Ý65 years) for all pathogens except Shigella, for which the highest age-specific average annual population mortality rate was in children <5 years (.2/1 million population). Overall, most deaths (58%; 318) occurred in persons ¡Ý65 years old. Listeria had the highest case fatality rate overall (16.9%), followed by Vibrio (5.8%), Shiga toxin-producing Escherichia coli O157 (0.8%), Salmonella (0.5%), Campylobacter (0.1%), and Shigella (0.1%).

Conclusions. Salmonella and Listeria remain the leading causes of death in the United States due to bacterial pathogens transmitted commonly through food. Most such deaths occurred in persons ¡Ý65 years old, indicating that this age group could benefit from effective food safety interventions.

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5. Notifications
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 pathogenecity; 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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