Vol. XIV No. 15 ~ EINet News Briefs ~ Jul 22, 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
- Ireland: H1N1 vaccine narcolepsy cases reported
- Australia: Influenza season picks up pace
- Viet Nam: H5N1 avian influenza strikes two provinces
- USA: Influenza vaccine shipments start for US market
- USA: MedImmune seeks license for 4-strain influenza vaccine

2. Infectious Disease News
- Australia: Hendra confirmed in sudden horse death
- Japan: First gonorrhea strain resistant to all available antibiotics
- New Zealand (Auckland): Extra precaution urged after measles outbreak
- Philippines: Manila hospital reports six leptospirosis deaths
- Russia (Astrakhan): Measles cases after three-year break
- Viet Nam: Man killed by anthrax
- Peru (Ayacucho): Pregnant woman with sylvatic rabies infection
- Peru (Piura): Man dies from bartonellosis
- Peru: First case of hantavirus pulmonary syndrome
- USA (Arizona): Man died from Europe E. coli infection
- USA (Indiana): One new case of measles reported
- USA (New York): Measles case confirmed
- USA (Utah): Six cases of measles confirmed in Cache County
- USA (Pennsylvania): 300 sickened in salmonella outbreak

3. Updates

4. Articles
- Analysis of CDC Social Control Measures using an Agent-based Simulation of an Influenza Epidemic in a City
- How the H1N1 Influenza Epidemic Spread among University Students in Japan: Experience from Shinshu University
- Surveillance of illness Associated with Pandemic (H1N1) 2009 Virus Infection among Adults using a Global Clinical Site Network Approach: The INSIGHT FLU 002 and FLU 003 Studies
- Cross-Species Transmission of a Novel Adenovirus Associated with a Fulminant Pneumonia Outbreak in a New World Monkey Colony
- Opioids and HIV/HCV Infection
- The Seroprevalence and Seroincidence of Enterovirus 71 Infection in Infants and Children in Ho Chi Minh City, Viet Nam
- Responses after One Dose of a Monovalent Influenza A (H1N1) 2009 Inactivated Vaccine in Chinese Population-A Practical Observation
- Weight of the IDSA/ATS Minor Criteria for Severe Community-Acquired Pneumonia
- Novel Arenavirus Infection in Humans, United States
- Novel GII.12 Norovirus Strain, United States, 2009–2010

5. Notifications
- International Symposium on Influenza and Other Respiratory Infections
- Influenza 2011: Zoonotic Influenza and Human Health
- 5th Vaccine and ISV Annual Global Congress

1. Influenza News

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:

Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 562 (329) (WHO 6/22/2011)

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

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

WHO’s timeline of important H5N1-related events (last updated 5/2/11):


Europe/Near East
Ireland: H1N1 vaccine narcolepsy cases reported
Irish drug regulators have received five more reports of narcolepsy cases that may be linked to the 2009 H1N1 vaccine, raising the nation's total so far to 13. The Irish cases are part of a larger probe by the European Medicines Agency (EMA) into links between narcolepsy and GlaxoSmithKline's Pandemrix 2009 H1N1 vaccine. Most of the cases have been reported from Scandinavian countries. The EMA report is expected sometime in July 2011. In April 2011, Ireland pulled its remaining Pandemrix doses.
(CIDRAP 7/11/2011)


Australia: Influenza season picks up pace
Flu activity in Australia is increasing, with the biggest spikes in South Australia, Queensland, and New South Wales states, the country's Department of Health and Ageing said in its most recent surveillance report. The 2009 H1N1 virus is the most frequently detected strain and it is circulating alongside influenza B. Antigenic analysis so far shows that Australia's circulating flu strains are a close match with the ones included in the seasonal flu vaccine. Queensland Health is reporting a six-fold increase in flu cases in Brisbane compared with the same time period in 2010. Dr. Gino Pecoraro, president of the Queensland chapter of the Australian Medical Association, said the early and large surge in the state's flu cases could relate to the area's unseasonable weather.
(Brisbane Times 7/9/2011)


Viet Nam: H5N1 avian influenza strikes two provinces
On 18 July 2011 Vietnam's animal health ministry stated that H5N1 avian influenza outbreaks in poultry had been detected in two provinces, Quang Tri on the north central coast and Phu Tho in northeastern Vietnam. The outbreaks sickened 3,704 birds in the two affected villages, and 3,704 more were destroyed to control the spread of the virus. Vietnam reported its last H5N1 outbreak in early June 2011 and is among the handful of countries where the disease is endemic in poultry.
(CIDRAP 7/18/2011)


USA: Influenza vaccine shipments start for US market
Companies that make flu vaccine for the US market announced that they have begun shipping their first doses for the 2011-12 flu season.

The flu vaccine for the 2011-12 season will contain the same three strains as 2010-11, including the 2009 H1N1 strain. In May 2011 the US Centers for Disease Control and Prevention (CDC) projected that manufactures will make a record 166 million to 173 million doses for the US market for the 2011-12 flu season. In 2010, the companies distributed 163 million doses.

On 18 July 2011, the US Food and Drug Administration (FDA) said in a statement that it has approved the flu vaccines made by the five companies.

Sanofi Pasteur, which supplies the largest portion of US flu vaccine, stated 18 July 2011 that it has started shipping two of the three vaccine products, Fluzone for adults and children and Fluzone High-Dose, which is targeted to those age 65 and older.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/jul1811shipping.html
(CIDRAP 7/18/2011)


USA: MedImmune seeks license for 4-strain influenza vaccine
In an effort to overcome the difficult problem of predicting which influenza B strain will circulate in any given season, MedImmune has filed for US approval of a quadrivalent (four-strain) flu vaccine containing two influenza B strains.

The idea of a quadrivalent flu vaccine has been discussed for several years, but MedImmune's application apparently is the first attempt to license such a vaccine in the United States. MedImmune's vaccine is a quadrivalent version of its licensed trivalent nasal spray vaccine, FluMist. The company, based in Gaithersburg, Md., announced on 18 July 2011 that the Food and Drug Administration (FDA) had received its supplemental license application.

Seasonal flu vaccines for many years have targeted three flu subtypes: A/H1N1, A/H3N2, and B. But in recent years type B viruses from two different lineages—Yamagata and Victoria—have circulated at varying and unpredictable levels. Because of production timelines, the strains to be used in seasonal flu vaccines must be chosen more than six months before the season starts. That requires flu experts to bet on which strains will be most common during the season, and they have had spotty success in picking the type B lineage. Vaccines targeting one B lineage have provided limited protection against the other, which has fueled interest in including both lineages in the vaccine.

The full article may be accessed at http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/jul1811medimmune.html
(CIDRAP 7/18/2011)


2. Infectious Disease News

Australia: Hendra confirmed in sudden horse death
Tests have confirmed that a horse that died in northern New South Wales (NSW) the week of 11 July 2011 was suffering from Hendra virus infection. The horse died suddenly at a property at Lismore on 14 July 2011. It is the fourth case of the bat-borne disease in New South Wales in recent months. The state's chief vet, Dr. Ian Roth, says a blood sample was taken from the horse, and tests on 17 July 2011 confirmed it has Hendra virus.

Dr. Roth says there were no apparent links to the two other NSW properties where horses died recently from the virus or to the outbreaks in Queensland. He says there is another horse on the quarantined Lismore property which is showing no sign of infection.

Dr. Roth says flying foxes were the most likely sources of infection. The NSW Department of Primary Industries is warning horse owners to take extra precautions to avoid flying foxes to prevent the spread of the virus.

There have also been six outbreaks of the virus in Queensland in less than a month. On Saturday 16 July 2011, two new outbreaks of the disease were confirmed in Queensland: one at Hervey Bay on the Fraser Coast and another at Boondall in Brisbane's north. Two sick horses were euthanized earlier in the week. Seven horses are being monitored as a result of the two new outbreaks in Queensland.

Queensland Health says it appears people who had contact with the horses have a low risk of infection.

Almost a dozen properties are now quarantined in Queensland due to the deadly virus. Dozens of people in NSW and Queensland are being tested for Hendra. Officials cordoned off areas at Sydney's Randwick Racecourse on 15 July 2011 because of fears Hendra could spread there for the first time.

A cross-border taskforce (including the chief vets of New South Wales and Queensland), scientists, health officers and the CSIRO, met for the first time on 13 July 2011 to plan a coordinated response to the virus.
(ABC News 7/18/2011)


Japan: First gonorrhea strain resistant to all available antibiotics
A sexual disease that is resistant to all drugs has been discovered by scientists. They warn the strain of super- Neisseria gonorrhoeae, the cause of gonorrhea could spread very quickly unless better treatments are developed. Although only one case has been confirmed, experts fear many more may have gone unreported.

Until now gonorrhea has been very easy to treat with antibiotics called cephalosporins. Patients usually need only a single pill or jab. But Swedish scientists who have analyzed the new strain found in Japan believe that over the decades the disease has mutated to become resistant to current treatments.

Magnus Unemo, of the Research Laboratory for Pathogenic Neisseria in Orebro, Sweden, described it as an alarming discovery. Since antibiotics became the standard treatment for gonorrhea in the 1940s, this bacterium has shown a remarkable capacity to develop resistance mechanisms to all drugs introduced to control it, he said. While it is still too early to assess if this new strain has become widespread, the history of newly emergent resistance in the bacterium suggests that it may spread rapidly unless new drugs and effective treatment programs are developed.

The new strain of the sexually transmitted disease called H041 was found in Japan and leaves doctors with no other option than to try untested medicines to combat it. Left untreated it can cause infertility in women and men and can be life threatening if it spreads to the blood and joints. Some 16,700 Britons are infected with gonorrhea every year and it is one of the most common sexually transmitted infections after chlamydia. The 16-24 age group accounts for almost half of all cases.
(ProMED 7/13/2011)


New Zealand (Auckland): Extra precaution urged after measles outbreak
Parents are being urged to take extra steps to stop the spread of measles as school holidays approach. The warning comes from the Ministry of Health, as 61 people have now been diagnosed with measles in Auckland's largest outbreak of the disease in 2011, with the number expected to continue rising.

Parents should check to insure that their family's immunizations are up-to-date, especially if they were to get on a plane, Ministry child and youth health adviser Pat Tuohy said. This is a good thing to do whenever you travel, but it is especially important these school holidays, as we have a serious measles outbreak in Auckland, and there is a risk that could spread to other parts of New Zealand or the Pacific, Dr. Tuohy said.

Dr Tuohy said immunization rates in New Zealand were not high enough to prevent measles spreading. To achieve that, the ministry needed to ensure 95% of 2-year-olds were fully immunized. The current immunizsation rate was about 90%.
(ProMED 7/17/2011)


Philippines: Manila hospital reports six leptospirosis deaths
With leptospirosis cases skyrocketing in the Philippines due to flooding throughout the archipelago, health officials are expressing alarm over the outbreak and warning citizens to avoid floodwaters or take precautions if they can't avoid it.

Officials from the San Lazaro Hospital in Manila reported 12 July 2011 that they have seen six people die due to the bacterial disease since 1 July 2011. The hospital has seen 37 total cases in the time frame.

The outbreak is large and growing. Dr. Lyndon Leesuy, program director of the Department of Health (DOH) Emerging and Re-emerging Infectious Diseases, said a total of 521 leptospirosis cases and 38 deaths were reported from 1 January to 25 June 2011.

The Philippines health department is warning citizens of the bacterial dangers that lurk in the floodwaters and what can be done to prevent potentially deadly infection. Health officials are advising people to not to wade in floodwaters or if it cannot be avoided, to wear protective gears like rubber boots to prevent leptospirosis.
(ProMED 7/15/2011)


Russia (Astrakhan): Measles cases after three-year break
Seventeen people in Astrakhan have been diagnosed with measles. These cases are the first after a three-year break. The region was considered to be measles-free; however, eight adults and nine children have been diagnosed with measles recently. The local public health authorities consider the cases to be imported cases, and blame the primary healthcare system for a failure to maintain an adequate level of immunization in the population.
(ProMED 7/10/2011)


Viet Nam: Man killed by anthrax
A man from the northern mountainous province of Lai Chau has been killed by anthrax with suspected infection from buffalo, a province medical official said Saturday 9 July 2011. The 40-year-old man, was killed after hospitalization at the medical center of Than Uyen District, said Pham Xuan Tan, a district reventive health official.

Tan said the man was among ten people admitted to the district hospital with anthrax since the beginning of June 2011. The dead man was only sent in when his condition had become critical with bleeding and sharp pains in the head, Tan said.

The man had earlier been involved in slaughtering a sick buffalo and developed a black burned spot on his arm afterward, according to investigation.

[ProMED note: Anthrax is sporadic in Viet Nam and most commonly seen in the northern provinces where livestock vaccination is not practiced. Cutaneous infections in humans need to be caught early and treated aggressively.

In this case the man developed meningitis, which is more common with human anthrax than many clinicians appreciate and bodes ill for the patient's future. Without treatment cutaneous anthrax can carry an over 20% risk of mortality. Viet Nam under-reports human cases. They appear to see some three to seven outbreaks in buffalo each year with up to more than 80 animals affected. This provides ample opportunity for the poor villagers to butcher affected animals.]
(ProMED 7/12/2011)


Peru (Ayacucho): Pregnant woman with sylvatic rabies infection
According to the Strategy for Prevention of Vectorborne Diseases of the Ayacucho Regional Health Directorate, a case of sylvatic rabies has been registered in a woman in the 27th week of pregnancy. The woman was a victim of a bat bite in the locality of Sanabamba, San Miguel district in La Mar province. According to the physicians, the patient is in good condition and as of 7 July 2011 has received three of the five intramuscular doses of rabies vaccine, scheduled over a period of 14 days. In addition, three cases of sylvatic rabies in animals have been registered in Vilcashuaman (capital of Vilcas Huaman province) and one case in Sanabamba, San Miguel district.

The Ayacucho Regional Health Director, Antonio Sulca, said, if one suffers bat bites, it is important for the residents in high risk areas to go to the nearest health posts to receive vaccine for sylvatic rabies. Also, they must use bed nets when resting or sleeping.

Given the alert for a possible outbreak of sylvatic rabies in Vilcas Huaman and La Mar provinces, a multi-sectorial meeting decided to promote public education, control, and prevention of sylvatic rabies infections due to bat bites in the different areas in Ayacucho. There was participation in the meeting by the Regional Agriculture office, the Civil Defense Subdirectorate, the Ayacucho regional government, SENASA (Servicio National de Sanidad Agraria; National Agricultural Health Service), and the directorates of Environmental Health, Epidemiology, and Health Promotion of the Regional Health Directorate.

It was reported that DIRESA (Direccion Regional de Salud; Regional Health Office) will intensify supervision, monitoring, information, and public education actions. As well, it is necessary to define risk areas to control the disease through use of bed nets, protective measures for houses, training of health personnel, and provision of rabies vaccine and rabies immune globulin to health posts.

The Civil Defense Subdirectorate of the Ayacucho regional government must assure provision of bed nets. The Agriculture Directorate will help with transport and personnel for monitoring and inspecting areas of risk.

[ProMED note: The report indicates animal rabies cases in two provinces, but does not specify which animals were involved. Sylvatic rabies in the American tropics refers to vampire bat transmitted rabies virus. The hematophagous bat most frequently involved is Desmodus rotundus. Its preferred hosts are cattle and equine animals. Humans are not frequently attacked, although it does occur occasionally. In a very remote area in Peruvian Amazonas, several Awajun natives have died of vampire bat transmitted rabies in February and March of 2011.]
(ProMED 7/11/2011)


Peru (Piura): Man dies from bartonellosis
A 19-year-old man died as a consequence of bartonellosis (also known as Carrion's disease and Peruvian wart) in the La Mercedes Hospital of Chiclayo (Lambayeque region). The young man was a farmer from Piura region who was referred to the hospital in Chiclayo after continually presenting fever. The illness led to his death on 8 July 2011.

The chief of general medicine of the hospital, Winston Maldonado, said that the health of the patient was compounded by a renal failure that finally caused his death. We were surprised that he had Carrion disease, a disease that was believed to have been eradicated, although it is an isolated case. We already notified the Regional Health Bureau to take all appropriate preventive measures, the doctor said.
(ProMED 7/15/2011)


Peru: First case of hantavirus pulmonary syndrome
The first case of hantavirus pulmonary syndrome (HPS) has been confirmed (ELISA and PCR) in the Peruvian Amazon, Iquitos, (Loreto region) Peru. Sadly, the case was fatal, involving a 29-year-old woman who worked as a nature tourist guide near Iquitos city. After a 20 day illness, she developed a clinical picture of serious respiratory insufficiency in the Hospital III Iquitos-EsSalud. The pulmonary disease specialist, Percy Sinti, was alert to the possibility of HPS, and arranged for samples to be taken that were sent to the National Institute of Health and the Center for Tropical Diseases Research of the US Navy based in Iquitos, which confirmed the physician's suspicions.

The patient died in the intensive care unit on 8 July 2011. Although reports of serological evidence of hantavirus infection, there has never been a confirmed case in Peru. Following the confirmation, epidemiological investigations of contacts and probable sites of infection and the search for wild rodents, probable virus reservoir hosts, have been initiated.
(ProMED 7/21/2011)


USA (Arizona): Man died from Europe E. coli infection
The death of an Arizona man and five other USA cases of E. coli O104:H4 infection were caused by the deadly foodborne outbreak that has ravaged Europe, federal health officials confirmed 8 July 2011.

The death of the man, who had recently visited Germany, is the first fatality outside Europe connected to the outbreak that has killed 50 in the EU, according to the CDC. Officials didn't identify him, but said he was older than 65 and lived in Northern Arizona.

Overall, six cases of confirmed infection with Shiga toxin-producing E. coli 0104:H4 have been confirmed in the USA, the CDC said. They include five people who recently traveled to Germany. Another victim likely became ill from close contact with a traveler.
(ProMED 7/11/2011)


USA (Indiana): One new case of measles reported
The number of confirmed measles cases in Noble County has remained the same, but Lagrange County is reporting that another person has contracted the disease.

The Noble County Health Department is working closely with the Indiana State Department of Health to contain the spread of measles. The outbreak started in late June 2011, when five people were diagnosed. In all, health officials have confirmed a total of 12 cases in Noble County and two in Lagrange County.

Doctors continue to recommend that people who think they may be infected limit their exposure to others. Symptoms include cold-like symptoms followed by high-fever and a rash.
(ProMED 7/10/2011)


USA (New York): Measles case confirmed
The Seneca County Health Department has confirmed that a student at New York Chiropractic College is a case of measles. This viral disease is airborne and highly contagious. A spokeswoman said the Seneca County Health Department is working with the New York State Department of Health as well as the college to implement control measures to prevent the disease from spreading throughout the community.
(ProMED 7/10/2011)


USA (Utah): Six cases of measles confirmed in Cache County
The Bear River Health Department has now confirmed a sixth case of measles in Cache County. The most recent case comes nearly 6 weeks after the first case of measles was confirmed in the county. While it appears the cases may be associated with the statewide outbreak, the health department has not identified a link at this time.

Health officials continue to investigate all possible measles cases and are tracking all contacts of confirmed cases in an effort to contain the outbreak and minimize the outbreak's impact on the community.
(ProMED 7/17/2011)


USA (Pennsylvania): 300 sickened in salmonella outbreak
Federal prison officials say over 300 inmates were sickened by salmonellosis at a northeastern Pennsylvania prison in June 2011. The Bureau of Prisons on 15 July 2011 said that 320 inmates and four staff were sickened at the USA Penitentiary-Canaan in Waymart in an outbreak linked to chicken fajitas served there in June 2011.

State health department spokeswoman Christine Cronkright had initially said more than 500 inmates and staff were sickened, but now says the prison bureau's numbers are likely more accurate. The state health department had also said the prison's kitchen was closed, but federal prison officials say it reopened 13 July 2011, after passing an inspection.
(The Washington Post 7/15/2011)


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

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

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

- Other useful sources
CIDRAP: Influenza A/H1N1 page:
ProMED: http://www.promedmail.org/
WHO H1N1 pandemic influenza update 115: http://www.who.int/csr/don/2010_08_27/en/index.html
CDC Teleconference results: Healthcare groups need to share emergency plans:
American Academy of Pediatrics Policy Statement: Recommendations for Prevention and Control of Influenza in Children, 2010-2011:


- 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.


Chinese Taipei
The Public Health Bureau of the Pingtung County government in Southern Taiwan announced 12 July 2011 its first case of Japanese encephalitis (JE) in 2011. The victim, a 44-year-old woman residing in Pingtung City, was diagnosed with the mosquito-borne virus on 11 July 2011, becoming the fourth person in Taiwan to contact the disease in 2011, said the bureau.

The woman began suffering from headache and fever on 4 July 2011 and was hospitalized 5 July 2011, where tests confirmed that she had been infected, health officials said. Inspections by the bureau revealed that the patient lived in proximity to rice paddies and chicken coops, which provide ideal breeding conditions for the Culex mosquitoes that carry the virus.

The public should avoid rice paddies, livestock quarters, ponds, and irrigation ditches at dusk, when the mosquitoes are at their most active, bureau officials said. To lower the chances of infection, long sleeves and pants should be worn, and mosquito spray repellant should be applied to exposed areas if activity in these places cannot be avoided, the officials added.

The Japanese encephalitis season is from May to October and infants should be vaccinated as soon as possible, the bureau said. According to the bureau, adults that work in high-risk areas can get vaccinated but must pay for the shots.
(ProMED 7/14/2011)

The Secretary of Health, Jose Angel Cordova, stated that an increase in dengue cases is expected during the second half of 2011. Currently, the number of ill people totals 850, with five deaths, compared to 8,000 and 18 deaths in 2010.
(ProMED 7/11/2011)

Mexico (Jalisco state)
The Secretariat of Health reported that there are three new dengue cases, bringing the total in Jalisco for 2011 to 68.
(ProMED 7/11/2011)

The Department of Health (DOH) has declared a dengue outbreak in five of six municipalities in Batanes. The DOH has reported one death due to dengue and 901 cases (as of 25 June 2011) compared to only one case in 2010, said DOH National Epidemiology chief Dr. Eric Tayag. The municipalities affected are Sabtang (63 cases), Basco (487 cases), Mahatao (18), Uyugan (47), and Itbayat (286). From 1 January to 25 June 2011, there were 29,898 cases and 185 deaths in the country, 11% lower than in the same period in 2010, which recorded 33,659 cases and 288 deaths.
(ProMED 7/18/2011)

Over 100 cases of dengue infection were reported in Maha Sarakham province. Recently, there were 155 cases treated at Maha Sarakham hospital and other government health centers. The highest number of cases was reported in Muang district (34 cases), Phayakkhaphum Phisai (29), and Borabue (17). The trend of the dengue outbreak is still increasing because of the rainy season and hot weather.

Dr. Suriya Ratanaparinya, Maha Sarakham Provincial health officer, has ordered health officers and public health volunteers to clean up the environment and spray to eradicate mosquito larvae.
(ProMED 7/18/2011)

Canada (Alberta)
As health authorities urge Albertans to guard against Lyme disease after five infected ticks were found as of 20 July 2011, a Calgary mother says she's frustrated her sick daughter hasn't been tested for the illness despite repeated requests.

The pinhead-sized ticks carrying the Borrelia burgdorferi bacteria that cause Lyme disease were spotted recently on four dogs and a cat, through Alberta's surveillance system, said the province's chief medical officer of health, Dr. Andre Corriveau. Alberta doesn't typically see a lot of the infected ticks, partially because they don't survive well in the dry climate.

The woman, whose daughter has been sick for nine days with a number of symptoms linked to Lyme disease, said she's frustrated the 14-year-old hasn't been tested for the illness, even if the possibility is remote. At least give parents the peace of mind you're going to rule it out and get tested. The girl has been suffering from a high fever, chronic neck and back pain, nausea, and lethargy since 10 July 2011.

An Alberta Health Services spokesman said the province follows Public Health Agency of Canada guidelines in ordering testing. The agency states that a diagnosis should be made after evaluating both the symptoms and the risk of exposure to infected ticks. A University of Calgary faculty of medicine professor who studies the Lyme disease bacteria said Alberta physicians must begin paying closer attention to the possibility the disease could rear up again in the province. A lot of physicians are under the impression that you can't even get Lyme disease in Alberta. Now things are changing, we see infected ticks, said George Chaconas, who holds the Canada research chair in Lyme disease. It needs to be considered a possibility by physicians.

Since the province began a surveillance program in 2007, roughly 25 ticks carrying the Lyme disease bacteria have been detected. The infected ticks in 2011 were found on pets in the Edmonton and Calgary areas. From 1989 to 2008, 20 cases of human Lyme disease were reported in Alberta. Most of the cases were linked to travel in the US or Europe. In 2010, the province identified about a dozen infected ticks.

Other parts of Canada, such as southern British Columbia and Nova Scotia, have larger populations of the bacteria-carrying ticks. Climate change could be a determining factor in a potential upswing of infected tick activity in Alberta, Chaconas contended.

The past two years, for example, have been particularly moist – the type of climate in which Lyme-carrying ticks thrive. As conditions change, ticks can move into the area and the disease does spread from place to place with climate change, said Chaconas.

Blood samples from suspected cases are first sent to a provincial lab. Then, to guard against false positive results, the sample is sent to a national lab in Winnipeg for further testing. Prevention is the best defense against the disease, Corriveau noted. Covering up outdoors and using insect repellent help protect against the infected ticks.
(Calgary Herald 7/20/2011)

Russia (Leningrad)
The public health officials for Leningrad Oblast region have announced 39 cases of Lyme disease. Overall 5,068 people have sought medical advice after tick bites. Tickborne encephalitis vaccine has been administered to 18,235 people, including 4,941 children. 2,350 acres of recreational areas, which include 1,536 acres of children's camps, have been treated against ticks.
(ProMED 7/19/2011)

Russia (Sverdlovsk)
Tens of people in Nizhniy Tagil have been diagnosed with Lyme disease; the doctors consider these numbers of cases massive. Nizhniy Tagil has become the worst affected city in Sverdlovsk Oblast, where the majority of the ticks are carriers of Borrelia burgdorferi. 76 people are under medical attention because of Lyme disease and more than ten of them are under 12 years old. In 66 cases the diagnosis has been laboratory-confirmed.
(ProMED 7/19/2011)


South Korea
A South Korean traveler returning home from an overseas trip was found to have contracted cholera, local health authorities said Monday 11 July 2011, the country's first case of the disease in 2011.

The unidentified patient, who recently visited Delhi and Varanasi in India, showed symptoms of the disease upon arrival at Incheon International Airport, the Korea Centers for Disease Control and Prevention (KCDC) said. The person tested positive for the Vibrio cholera O1, Ogawa it said.

The KCDC said it has acquired a list of 10 other people who traveled with the cholera patient to check if they had caught the disease as well. It stressed that people traveling to India and Southeast Asian countries during the summer months should be on guard against the disease.
(ProMED 7/11/2011)


4. Articles
Analysis of CDC Social Control Measures using an Agent-based Simulation of an Influenza Epidemic in a City
Yang Y, Atkinson PM, Ettema D. BMC Infectious Diseases. 18 July 2011; 11:199. doi:10.1186/1471-2334-11-199.
Available at http://www.biomedcentral.com/1471-2334/11/199

Background. The transmission of infectious disease amongst the human population is a complex process which requires advanced, often individual-based, models to capture the space-time details observed in reality.

Methods. An Individual Space-Time Activity-based Model (ISTAM) was applied to simulate the effectiveness of non-pharmaceutical control measures including: (1) refraining from social activities, (2) school closure and (3) household quarantine, for a hypothetical influenza outbreak in an urban area.

Results. Amongst the set of control measures tested, refraining from social activities with various compliance levels was relatively ineffective. Household quarantine was very effective, especially for the peak number of cases and total number of cases, with large differences between compliance levels. Household quarantine resulted in a decrease in the peak number of cases from more than 300 to around 158 for a 100% compliance level, a decrease of about 48.7%. The delay in the peak day was about 3 to 17 days. The total number of cases decreased to a 3635-5403 range, that is, 63.7%-94.7% of the baseline value. When coupling control measures, household quarantine together with school closure was the most effective strategy. The resulting space-time distribution of infection in different classes of activity bundles (AB) suggests that the epidemic outbreak is strengthened amongst children and then spread to adults. By sensitivity analysis, this study demonstrated that earlier implementation of control measures leads to greater efficacy. Also, for infectious diseases with higher basic reproduction number, the effectiveness of non-pharmaceutical measures was shown to be limited.

Conclusions. Simulated results showed that household quarantine was the most effective control measure, while school closure and household quarantine implemented together achieved the greatest benefit. Agent-based models should be applied in the future to evaluate the efficacy of control measures for a range of disease outbreaks in a range of settings given sufficient information about the given case and knowledge about the transmission processes at a fine scale.


How the H1N1 Influenza Epidemic Spread among University Students in Japan: Experience from Shinshu University
Uchida M, Tsukahara T, Kaneko M, et al. Am. J of Infection Control. 18 July 2011. doi:10.1016/j.ajic.2011.03.012.
Available at http://www.ajicjournal.org/article/PIIS0196655311002306/abstract

Background. A worldwide outbreak of influenza A/H1N1 occurred in 2009. Little information is available regarding how the epidemic spread among young people, who composed the majority of individuals infected with this virus. We assessed the route of transmission of H1N1 among university students at Shinshu University, Japan.

Methods. A total of 11,424 students were monitored between August 2009 and March 2010, and those who were diagnosed with confirmed, probable, or suspected H1N1 at a hospital or clinic were registered based on self-report to the university. Data including date of onset and suspected infection route were collected from the affected patients.

Results. Of the 11,424 students, 1,016 (8.9%) were infected with H1N1. In most infected students, the suspected transmission route was associated with club activity, followed by close contact with friends and through lectures or laboratory work. After suspension of activity by clubs with more than 2 infected members, the number of infected individuals decreased.

Conclusion. H1N1 influenza spread in the university through specific routes, including club activity, close contact with friends, and lectures or laboratory work. During future outbreaks of influenza, interventions to reduce transmission through these routes may be effective infection control strategies in university students.


Surveillance of illness Associated with Pandemic (H1N1) 2009 Virus Infection among Adults using a Global Clinical Site Network Approach: The INSIGHT FLU 002 and FLU 003 Studies
Dwyer DE, and The INSIGHT Influenza Study Group. Vaccine. 22 July 2011; 29 (Suppl. 2) B56-B62. doi:10.1016/j.vaccine.2011.04.105.
Available at http://www.sciencedirect.com/science/article/pii/S0264410X11006712

Abstract. The novel pandemic influenza A (H1H1) 2009 virus spread rapidly around the world in 2009. The paucity of prospective international epidemiologic data on predictors of clinical outcomes with pandemic (H1N1) 2009 virus infection stimulated the INSIGHT network, an international network of community and hospital-based investigators, to commence two worldwide clinical observational studies to describe pandemic (H1N1) 2009 virus activity.

The purpose of these two studies was to estimate the percent of adult patients with illness due to laboratory-confirmed pandemic (H1N1) 2009 virus infection that experience clinically significant outcomes and to study factors related to these outcomes.

Enrollment commenced in October 2009 and will continue until August 2011: as of the end of 2010, 62 sites in 14 countries in Australasia (12 sites), Europe (37) and North America (13) have enrolled 1365 adult patients, with 1049 enrollments into the FLU 002 outpatient study and 316 into the FLU 003 hospitalization study. These ‘in progress’ INSIGHT influenza observational studies may act as a model for obtaining epidemiological, clinical and laboratory information in future international disease outbreaks.


Cross-Species Transmission of a Novel Adenovirus Associated with a Fulminant Pneumonia Outbreak in a New World Monkey Colony
Chen EC, Yagi S, Kelly KR. et al. PLoS Pathogens. 7(7): e1002155. doi:10.1371/journal.ppat.1002155.
Available at http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1002155

Abstract. Adenoviruses are DNA viruses that naturally infect many vertebrates, including humans and monkeys, and cause a wide range of clinical illnesses in humans. Infection from individual strains has conventionally been thought to be species-specific. Here we applied the Virochip, a pan-viral microarray, to identify a novel adenovirus (TMAdV, titi monkey adenovirus) as the cause of a deadly outbreak in a closed colony of New World monkeys (titi monkeys; Callicebus cupreus) at the California National Primate Research Center (CNPRC). Among 65 titi monkeys housed in a building, 23 (34%) developed upper respiratory symptoms that progressed to fulminant pneumonia and hepatitis, and 19 of 23 monkeys, or 83% of those infected, died or were humanely euthanized. Whole-genome sequencing of TMAdV revealed that this adenovirus is a new species and highly divergent, sharing <57% pairwise nucleotide identity with other adenoviruses. Cultivation of TMAdV was successful in a human A549 lung adenocarcinoma cell line, but not in primary or established monkey kidney cells. At the onset of the outbreak, the researcher in closest contact with the monkeys developed an acute respiratory illness, with symptoms persisting for 4 weeks, and had a convalescent serum sample seropositive for TMAdV. A clinically ill family member, despite having no contact with the CNPRC, also tested positive, and screening of a set of 81 random adult blood donors from the Western United States detected TMAdV-specific neutralizing antibodies in 2 individuals (2/81, or 2.5%). These findings raise the possibility of zoonotic infection by TMAdV and human-to-human transmission of the virus in the population. Given the unusually high case fatality rate from the outbreak (83%), it is unlikely that titi monkeys are the native host species for TMAdV, and the natural reservoir of the virus is still unknown. The discovery of TMAdV, a novel adenovirus with the capacity to infect both monkeys and humans, suggests that adenoviruses should be monitored closely as potential causes of cross-species outbreaks.


Opioids and HIV/HCV Infection
Wang X, Zhang T, Ho WZ. J. Neuroimmune Pharmacol. 14 July 2011. [Epub ahead of print]
Available at http://www.ncbi.nlm.nih.gov/pubmed/21755286

Abstract. Since human immunodeficiency virus (HIV) and hepatitis C virus (HCV) share the same modes of transmission and common risk factors for infection, co-infections with HIV and HCV are frequently found in injection drug users (IDUs). IDUs represent one of the largest reservoirs of HIV as well as HCV in the United States. These two pathogens are also likely to be responsible for the highest infectious disease morbidity and mortality rates among IDUs. IDUs frequently involve the abuse of heroin, the most common abused opiate. Opiates have been suggested to have a cofactor role in the immunopathogenesis of HIV disease, as they have the potential to compromise host immune responses and enhances microbial infections. Although in vitro studies have yielded relatively agreeable data that morphine, the active metabolite of heroin, exacerbate HIV infection/replication, epidemiologic studies as well as in vivo non-human primate investigations on the impact of opiate abuse on HIV disease progression have yielded the conflicting data. Given immunomodulation and immunocompromising effect as well as demonstrated impact to enhance HIV replication in vitro, it is reasonable to believe that opiate abuse is a facilitator in HIV and/or HCV disease progression. However, much remain to be learned about the mechanisms of opiate-mediated broad influence on host immunity and viral expression. Thus, more extensive studies are needed in order to determine the effects of different conditions of opiate abuse and to define the understanding of the role of opiate in modulating HIV and/or HCV disease progression.


The Seroprevalence and Seroincidence of Enterovirus 71 Infection in Infants and Children in Ho Chi Minh City, Viet Nam
Tran CB, Nguyen HT, Phan HT, et al. PLoS One. 12 July 2011;6(7):e21116.
Available at http://www.ncbi.nlm.nih.gov/pubmed/21765891

Abstract. Enterovirus 71 (EV71)-associated hand, foot and mouth disease has emerged as a serious public health problem in South East Asia over the last decade. To better understand the prevalence of EV71 infection, we determined EV71 seroprevalence and seroincidence amongst healthy infants and children in Ho Chi Minh City, Viet Nam. In a cohort of 200 newborns, 55% of cord blood samples contained EV71 neutralizing antibodies and these decayed to undetectable levels by 6 months of age in 98% of infants. The EV71 neutralizing antibody seroconversion rate was 5.6% in the first year and 14% in the second year of life. In children 5-15 yrs of age, seroprevalence of EV71 neutralizing antibodies was 84% and in cord blood it was 55%. Taken together, these data suggest EV71 force of infection is high and highlights the need for more research into its epidemiology and pathogenesis in high disease burden countries.


Responses after One Dose of a Monovalent Influenza A (H1N1) 2009 Inactivated Vaccine in Chinese Population-A Practical Observation
Sun F, Zhang Y, Tian D, et al. Vaccine. 15 July 2011. [Epub ahead of print].
Available at http://www.ncbi.nlm.nih.gov/pubmed/21767595

Background. The globally large-scale immunization was the most important method of controlling the 2009 pandemic influenza.

Methods. We conducted an observational clinical trial, including 148 adults aged 18-60 years to evaluate the safety and immunogenicity of a licensed 2009 H1N1 influenza vaccine. All subjects received a single 15-μg dose of a monovalent, unadjuvanted inactivated vaccine. Antibody titers were measured by means of hemagglutinin-inhibition assays and neutralization assays based on Real-Time Cell Analyzer (RTCA) instruments at baseline, 7 days and 21 days after vaccination.

Results. Local and systemic reactions were respectively reported by 19.1% and 22.1% of subjects. All adverse events were mild to moderate in intensity, without any deaths or serious events. By day 21 after vaccination, hemagglutinin-inhibition antibody titers of 1:40 or more were achieved in 101 of 123 (82.1%) subjects and the geometric mean titers (GMTs) increased to 1:95.27. For neutralization assays, all subjects could provide the protection against wide influenza virus, with the GMT of 1:525.44. Moreover, the rates of seroconversion, as measured using hemagglutinin-inhibition assays and neutralization assays, were 73.98% and 91.87% of subjects, respectively.

Conclusions. A single 15-μg dose of a monovalent, unadjuvanted inactivated 2009 H1N1 influenza vaccine was well tolerated, and induced a protective immune response in the majority of subjects aged 18-60 years (clinical trials gov number, NCT01055990).


Weight of the IDSA/ATS Minor Criteria for Severe Community-Acquired Pneumonia
Guo Q, Li HY, Zhou YP, et al. Respir Med. 15 July 2011. [Epub ahead of print].
Available at http://www.ncbi.nlm.nih.gov/pubmed/21764276

Background. The 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) guidelines defined severe community-acquired pneumonia (CAP) when patients fulfilled three out of nine minor criteria. Whether each of the criteria is of equal weight is not clear. The purpose of this study was to determine the weight of the minor criteria.

Methods. 1230 adult patients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively.

Results. Hospital mortality rose sharply from 0.3%, 1.0% and 3.3%, respectively, for patients with none, one and two minor criteria to 10.5% for patients with three minor criteria. Arterial oxygen pressure/fraction inspired oxygen (PaO(2)/FiO(2)) ≤ 250 mm Hg, confusion, and uremia had the strongest association with mortality (Odds ratio, 22.162, 22.148, 16.343; respectively). Leukopenia, hypothermia, and hypotension were not associated with mortality. Confusion and uremia showed independent relationships with mortality (Odds ratio, 9.296, 8.493; respectively). Sequential organ failure assessment (SOFA) scores and costs increased significantly with the number of minor criteria present. Uremia and PaO(2)/FiO(2) ≤ 250 mm Hg were most strongly associated with SOFA scores [rank correlation coefficient (r(s)), 0.352, 0.336; respectively]. PaO(2)/FiO(2) ≤ 250 mm Hg and confusion were in closest relation to hospital length of stay (LOS) (r(s), 0.114, 0.114; respectively). PaO(2)/FiO(2) ≤ 250 mm Hg and multilobar infiltrates were most strongly associated with costs (r(s), 0.257, 0.196; respectively).

Conclusions. The individual 2007 IDSA/ATS minor criteria for severe CAP were of unequal weight in predicting hospital mortality, SOFA scores, hospital LOS, and costs.


Novel Arenavirus Infection in Humans, United States
Milazzo ML, Campbell GL, Fulhorst CF. Emerg Infect Dis. August 2011 [Epub ahead of print]. doi:10.3201/eid1708.110285.
Available at http://www.cdc.gov/eid/content/17/8/pdfs/11-0285.pdf

Abstract. Immunoglobulin G against Whitewater Arroyo virus or lymphocytic choriomeningitis virus was found in 41 (3.5%) of 1,185 persons in the United States who had acute central nervous system disease or undifferentiated febrile illnesses. The results of analyses of antibody titers in paired serum samples suggest that a North American Tacaribe serocomplex virus was the causative agent of the illnesses in 2 persons and that lymphocytic choriomeningitis virus was the causative agent of the illnesses in 3 other antibody-positive persons in this study. The results of this study suggest that Tacaribe serocomplex viruses native to North America, as well as lymphocytic choriomeningitis virus, are causative agents of human disease in the United States.


Novel GII.12 Norovirus Strain, United States, 2009–2010
Vega E, Vinjé J. Emerg Infect Dis. August 2011. doi: 10.3201/eid1708.110025. [Epub ahead of print]
Available at http://www.cdc.gov/eid/content/17/8/pdfs/11-0025.pdf

Abstract. In October 2009, a novel GII.12 norovirus strain emerged in the United States and caused 16% of all reported norovirus outbreaks during the winter season. Sequence analysis demonstrated a recombinant virus with a P2 region that was largely conserved compared with previously sequenced GII.12 strains.


5. Notifications
International Symposium on Influenza and Other Respiratory Infections
Beijing, China, 2-4 August 2011
We invite you to attend this conference to engage in discussions with world-leading experts from Fogarty International Center of NIH, US CDC, the World Health Organization (WHO), Johns Hopkins Bloomberg School of Public Health, and China CDC. Topics will include the surveillance, disease burden, virology, epidemiology, and vaccination policy of influenza and other respiratory infections caused by Streptococcus pneumonia and Haemophilus influenza type B in China, as well as in the Asia Pacific region.
Additional information at http://www.influenza-forum.com/index_en.asp


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


5th Vaccine and ISV Annual Global Congress
Seattle, Washington, United States, 2-4 October 2011
The annual Vaccine Congress is the leading global forum for the exchange of new ideas on the development of vaccines for infectious and non-infectious diseases. Now in its fifth year, the annual Vaccine Congress has become the forum for the exchange of ideas to accelerate the rate at which vaccines can come to benefit the populations that need them.
Additional information at http://www.vaccinecongress.com